Health care paradigms in transition

A. A. Franco, H. Bouma, J. E.M.H. Van Bronswijk

Research output: Contribution to journalReview articlepeer-review

12 Citations (Scopus)


Given the current state of the welfare state, rethinking the prevailing health care paradigm is important as health care services try to adapt to the demographic, economic, political, environmental transformation, and rapid technological innovation. The basic focus of the medical paradigm is fundamentally unchanged since the time of Hippocrates: disease management driven mainly by the curative treatment. This paper argues that a new paradigm of 'functional health' is now beginning to emerge. Its starting point is not disease and treatment, but rather a person's functional ability. This approach accords the individual a more central role as the person often best aware of his or her functional limitations. Although the health professionals remain in charge of acute and life threatening situations, when it comes to functional ability, the health professional acts as a counselor or facilitator. In terms of the World Health Organisation (WHO) classifications, this corresponds to a shift from the International Classification of Diseases (ICD), toward the International Classification of Functioning, Disability and Health (ICF). This new paradigm is potentially sustainable: it can combine simplicity with best quality, cost effectiveness with lack of waste, and use robust new technologies to the utmost. The new paradigm maintains the essence of the Hippocratic paradigm, but broadens the scope to health care issues and health care services so that important theoretical, educational, operational, and economic aspects can be accommodated. This paper looks into the implications of this transition and what can be done to ease the transition of focus from cure to care, from medical health to functional health.

Original languageEnglish
Pages (from-to)5-10
Number of pages6
Issue number1
Publication statusPublished - 2014


  • Functional health
  • Health care paradigm
  • Hippocrates
  • ICD
  • ICF


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