Redefining Health Care Systems

This book provides a scientific and personal perspective on health services research over the last half-century. Its purpose is to suggest how that science base, constructed over decades of sustained effort, can stimulate innovative thinking about ways to make health care systems safer, more efficient, more cost-effective, and more patient-centered even as they respond to the needs of diverse communities. The initial essay provides a perspective on the major achievements of health services research over five decades and argues that almost any reasonable health policy can work if the policy takes the relevant science into account. The second section puts a human face on the evolution of some of the core facts: In a series of stories, Robert Brook describes his personal encounters with health services research and the medical establishment. The third section features short commentaries on specific issues, originally published in JAMA: The Journal of the American Medical Association. Many of the commentaries highlight the role that physicians could, or should, play as thought leaders. A final commentary, reprinted with permission from the Journal of General Internal Medicine, emphasizes that the future approach to developing health policies should feature big ideas and big interventions.