Biopsychosocial healthcare
Last updated: 25 September 2025
The medical model and biomedical healthcare are two of many terms used to describe the traditional and culturally dominant approach to illness and health. It underpins the World Health Organisation (WHO) definition of health, introduced in 1948: a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Although widely criticised, it remains the official definition. A Google search for a definition of biomedical healthcare or the biomedical model usually leads to a paper Peter Halligan and I published in 2004. There is no definitive text because it evolved alongside the Scientific Revolution. (The Invention of Science. David Wootton. 2016. A great book.)
For many years, rehabilitation has been based on the biopsychosocial model of illness, and the process of rehabilitation is based on that model. However, rehabilitation is not the only healthcare speciality to use that model. To a greater or lesser extent, it influences psychiatry, including learning disabilities, geriatrics, paediatrics, palliative medicine, and, most importantly, general practice (family medicine). A biopsychosocial approach is now required in UK medical student training, where students must apply biomedical, scientific, psychological, and social science principles. Unfortunately, the model is not required; the principles are applied in accordance with the biomedical approach.
This post will explore the differences between biomedical and biopsychosocial healthcare healthcare approaches based on a biomedical model and a biopsychosocial model.
Table of Contents
Introduction – models.
This post explores how healthcare is conceived and understood, as this perspective will determine what people expect, what healthcare professionals do, what is funded, and many other vital matters. The term typically used is model, most notably in the phrase, the medical model. As models are central to this post, I will start by discussing what I mean by a model.
Models
Establishing the meaning of the word is a challenging task. Roman Frigg lists over 100 types of models used in science, and his book, Models and Theories: A Philosophical Inquiry, reviews many aspects of models in its 490 pages. A slightly shorter review by Roman Frigg covers Models in Science, and Eiko Fried (2020) introduces a journal issue on models by discussing “Theories and Models: What They Are, What They Are For, and What They Are About.”
This post discusses concepts, not objects, and is therefore concerned with conceptual models, which are cognitive entities. They can be represented visually in drawings, but they are not tangible.
I am concerned about the concepts used in models that influence healthcare, including how it is provided and its objectives. The model will accomplish the following.
A healthcare model establishes the concepts of interest. For example, although justice is a crucial concept in many situations, it does not directly impact healthcare, whereas depression and spasticity, two common healthcare issues, are direct healthcare matters. The model determines the scope of healthcare’s interests.
Second, a model will imply the nature of interrelationships between different concepts, for example, that low blood pressure may be associated with fainting. The interrelationships may be based on theory, empirical evidence, or may just be implied. A model based on a theory will tend to be more detailed.
Third, models provide an analytical framework or structure that can be utilised in various ways, such as categorising data items, exploring how factors influence one another, and determining appropriate actions. Everyone uses an explanatory model of health to make personal decisions about whether an experience signifies a health issue and, if so, what steps to take. Healthcare professionals also employ an explanatory model, which is often significantly different from the patient’s model.
Next, a model will, either explicitly or implicitly, determine how healthcare is organised, the processes involved, and the conceptual aim of healthcare. This is evident when hospitals assess whether someone is ‘ready for discharge’; if the diagnosis has been made and treated sufficiently to attain physiological homeostasis, the hospital considers them ready for discharge, even if, for example, they are semi-conscious and require nursing care.
Models are closely connected to theories. Some models, like those related to planetary movement around the sun, are simply another expression of the theory. Others, such as the biomedical and biopsychosocial models, originate from various sources, which may include theories that cover parts of the model.
Some models have no factual basis other than beliefs, and many historical models of health fall into this category. An individual’s explanatory model of illness often includes components based on their beliefs. Arthur Kleinman has demonstrated how culture influences personal explanatory models of health and system models of healthcare.
The two models: biomedical and biopsychosocial.
The biomedical model has developed since the Scientific Revolution began in the 1500s and is a scientifically based framework centred on the human body, its structures, and functions. Although healthcare practitioners clearly recognise that many people suffer from more than one disease, many illnesses are chronic and incurable, and some are not caused by disease, the default assumption remains that an identifiable disease underpins all illnesses and that a cure will eradicate them.
The biomedical model is reductionist and inward-looking. It increasingly focuses on genetic and other lower-level systems. There is no explicit description of the model; I have outlined my interpretation in two articles, one published in the British Medical Journal in 2004 and another in Clinical Rehabilitation in 2015. I have explicitly discussed it on this site. Its main domains of interest are shown in the MindMap below, and a more detailed MindMap is available here.
The limitations of the basic biomedical model were recognised in the 1800s when the significant influence of poverty and public health on population health was acknowledged, and they became a focus for societal action. For example, Victorian Britain invested heavily in sewers and clean water, and began to care for its people; Germany, on the other hand, improved social security.
In the twentieth century, interest increased in many other fields, including psychology, sociology, and epidemiology. The issues related to long-term illness and disability became urgent due to war injuries and epidemics like poliomyelitis. Simultaneously, ideas such as holism and general systems theory developed, culminating in the explicit formulation of the biopsychosocial model of illness.
This model adopts a much broader perspective, is more outward-looking, and emphasises the many factors beyond the body that influence health and illness in individuals, not just in populations. Since its first description in 1977, the model has evolved, and I refer to it as the holistic biopsychosocial model to highlight the domains added by the World Health Organisation, Peter Halligan and me. The model is extensively described on this site, including an overview.
Its main domains of interest are shown below. Whereas the biomedical model has five domains, the biopsychosocial model has ten.
Each model is associated with its approach to healthcare. I will refer to them as biomedical healthcare, which is the traditional and widely considered to be the only approach, and biopsychosocial healthcare, which has not been explicitly described before.
Comparison of biomedical and biopsychosocial healthcare
This post will consider each healthcare approach on five aspects:
- What type of system is it? Open or closed?
- What does the healthcare system consider? The person or the body?
- What is the focus of attention? Activities or symptoms?
- What principles underlie the approach?
- What three clinical features encapsulate the approach?
A detailed MindMap giving an overview of the comparison can be opened in a new tab to keep available as you read the text.
Subject of interest.
The model’s central point of attention determines its scope and the clinical features it focuses on.
Biomedical
The biomedical model’s focus is the body, examining its structures and functions. Although medical student training now encompasses broader fields such as sociology and psychology, the primary focus remains on human anatomy, physiology, and other biological sciences, including genetics, biochemistry, and pharmacology. For instance, the UK General Medical Council’s curriculum requires medical students to apply principles from scientific (biomedical), psychological, and social sciences. This suggests these are used within a biomedical framework; there is no mention of a biopsychosocial approach.
This focus on the body causes difficulties when considering psychological illnesses or the impact of mental health on other diseases and offers no formal recognition of contextual factors. Many important practical consequences arise, such as the difficulty of determining when someone is ‘ready for discharge’ or eligible for Continuing Healthcare funding.
The scientific approach was closely linked with a division between body and mind, and the biomedical model concentrates on the body. Although psychiatry is a recognised healthcare speciality, the struggle to equate mental health with physiological health resulted in physical and drug treatments for many socially influenced issues. Alcoholism, for example, was regarded as a disease beyond the individual’s control.
At the same time, it pays little attention to a person’s environment, except epidemiologically, for example, by looking for toxins that cause disease. Instead, it is mainly concerned with bodily risk-benefit.
Last, the patient is typically considered a passive recipient of healthcare.
Biopsychosocial
The biopsychosocial model’s subject is the person, which immediately prompts consideration of all aspects of an individual, including personal factors, priorities, values, and their context.
Focusing on an individual fosters an understanding that many factors influence illness, and that a single, overarching diagnosis is often unattainable. In biopsychosocial healthcare, the goal is to develop a formulation, a practice that is central to most psychiatric clinical work. I have discussed the process of formulation and the skills required to formulate effectively.
It necessarily compels one to be truly person-centred, which most medicine aims for but often falls short, either because they interpret the phrase differently or because the biomedical management of healthcare does not seek to be person-centred. Therefore, one considers all aspects of the person – their experience, functioning, and social roles.
It avoids mind-body dualism, which is accidentally but strongly associated with the biomedical approach to health. It acknowledges the relevance of emotions as an integral facet of a person, likely to impact more physical matters.
Since the focus is on the person, they are inherently active participants and should be regarded as partners in all activities and decisions. Additionally, one must respect their choices, values, and so on, while examining their physical and social contexts not only as causative or aggravating factors but also as treatment targets.
Scope of the model.
The scope of the illness model will determine the scope of the healthcare system associated with it.
Biomedical
The biomedical model has a narrow scope, focusing inward from the body to the organs, organ systems, and lower levels such as genetics, diseases affecting cell organelles, and cell membranes.
It is therefore a relatively closed system that does not take into account broader matters. Of course, almost all healthcare professionals working within the biomedical system are acutely aware of and concerned about wider patient and social issues, but the healthcare system itself is not.
It assumes a single cause for symptoms and a relatively simple relationship between disease and illness, so that outcomes should be predictable. Basic physiological measures will be moderately predictable, but any outcome influenced by psychological, environmental, or social factors will be unpredictable. Consequently, much biomedical research utilises physiological measures, such as weight, blood pressure, or respiratory function, to evaluate treatment. These outcomes are not the patient’s primary concern.
Biopsychosocial
The holistic biopsychosocial model’s scope encompasses all aspects of a person’s life. Therefore, it includes the biomedical approach, but the underlying disease, if present, has only a relatively small influence in many cases.
A key feature of the biopsychosocial model is that it does not require the individual to have an identifiable pathology. Illness can occur when the person’s biopsychosocial balance is disrupted and not restored. Many symptoms and changes in function have no pathology to explain them; these may be referred to as functional illnesses.
Furthermore, events such as bereavement or the loss of a valued social role may appear as an illness with symptoms if viewed through a biomedical lens. In a biopsychosocial context, however, they are usually regarded not as an illness but as a natural response, where the individual requires support during a normal process of adjustment, without the need for a diagnosis.
Thus, the biopsychosocial healthcare system can manage individuals where there is debate, disagreement, or uncertainty about the presence of any pathology, as is the case for chronic fatigue syndrome, Long Covid, and chronic pain, for example. Patients with these conditions are often discharged from biomedical healthcare services, either because they are not considered to have a medical condition or because it is deemed a low priority, as there is no disease.
The flip side is that biopsychosocial healthcare necessarily involves many organisations outside the health sector. Many actions needed to help a person with a spinal cord injury resume active roles in society require input from housing, employment, and often social services to provide care.
The multiple factors that influence a person’s behaviour and capabilities often interact, making the effects of interventions challenging to predict. It is a mathematically complex model.
Clinical focus.
The model’s scope determines the primary clinical focus of the healthcare approach.
Biomedical
The goal of the biomedical approach is to diagnose, usually, a single internal pathology. Traditionally, because organs are rarely visible, clinicians start with symptoms—bodily experiences that may originate from and indicate the underlying disease. The diagnostic process also involves a physical examination, complemented by specialised technologies that allow investigation of internal anatomy or function. However, more detailed investigations of genes, specific chemicals, and related factors are increasingly accessible.
It will also examine evidence of factors that affect prognosis, the most effective specific treatment, the chances of success, the associated risks, and other relevant outcomes. The aim is to determine the cause and develop a targeted curative or ameliorative treatment.
The biomedical approach now faces numerous challenges. Multimorbidity complicates the interpretation of symptoms and other abnormal findings, making it difficult to determine whether an existing or new disease is causing the patient’s problems.
The strong impact of emotions and other psychological factors on symptom severity can create uncertainty about the risk-benefit ratio. Functional disorders are not manageable within this framework, but useless attempts to find a diagnosis may harm the patient.
Biopsychosocial
For the biopsychosocial approach, the usual starting point is the activities a patient can no longer perform or does so less effectively. The clinician should undertake a person-centred assessment, listening carefully without interrupting. The person will then typically refer to both the social consequences of their problems and the impairments causing limitations on their activities. They will often mention the underlying medical diagnosis. As a result, you will naturally gather information from four domains.
However, the clinician must gather sufficient information from each domain of the model to enable a formulation that will facilitate discussions of priorities and planning of subsequent actions. Consequently, they should consider all ten domains of the model, although detailed information is only necessary from eight; the temporal context is usually clear but should still be regarded. In simple cases, the information from each domain may be minimal, but completely neglecting a domain is risky.
Structured checklists can be helpful, but they also pose risks. They might cause individuals to limit questioning to the suggested items or overlook the patient’s input. I have written about assessment and data collection in rehabilitation here and here. Completing an assessment of case complexity, such as the OCCAM or INTERMED, after gathering information, aids in recording details and acts as a check on the scope of data collection.
The formulation should cover causative and exacerbating factors, the extent of change arising from the illness, and, most importantly, an intervention strategy and potential targets for treatment.
The model’s theories
Both models have evolved, and change continues. As they evolved, they stimulated the development of theories. I will outline some.
Biomedical
The biomedical model of healthcare is founded on theories of disease, physiology, pharmacology, etc. Many of these individual theories are backed by substantial evidence. The overarching theoretical assumptions are that:
- Disease causes symptoms, and conversely, symptoms are due to disease
- There is usually a single disorder accounting for new symptoms, recognising that people accumulate diseases
- If the disease is treated, the person will return to their previous level of health
The approach lacks a clear theory on psychological illnesses, whether major or minor. In practice, it still assumes a distinction between mental and physical factors.
Modern biomedical healthcare recognises that a cure is not always possible and mainly focuses on maintaining physiological balance, known as homeostasis. It now emphasises personalised medicine, individualising treatment to the patient rather than being person-centred, meaning treatments can be tailored according to a person’s genetic profile.
Biopsychosocial
The biopsychosocial model of illness and healthcare encompasses various theories, each usually focused on a specific group of patients. For instance, psychoanalytic and psychodynamic theories have influenced certain aspects of mental health practice, while learning theories are starting to inform parts of rehabilitation. Additionally, research seeks to deepen the understanding of how factors across different domains interact.
However, since around 1980, rehabilitation has been based on a single analytic theory that applies to all aspects: the biopsychosocial model of illness. This has provided a solid analytical foundation and a useful classification system (The International Classification of Functioning).
Nonetheless, until 2024, there was no convincing overarching treatment theory. In 2024, I published a General Theory of Rehabilitation, which, I would argue, probably applies across all biopsychosocial healthcare specialities; that argument is too extensive for this post. The theory is elaborated on in several pages here.
Essentially, it implies that people naturally and inevitably adapt when ill, potentially across many areas, and that the purpose of rehabilitation is to support and improve this adaptation. The two Mind Maps below offer an overview and details on the roles of rehabilitation services.
Moreover, I have empirically established the types of treatment that underlie much effective rehabilitation. The crucial feature is that treatment must be tailored to meet the particular needs of each patient.
Thus, there are now two theories: one provides an analytic framework and the other highlights how rehabilitation can help.
Treatments
The treatment schedules differ, reflecting the two different approaches: one favours treatments with a single purpose, control and reversal of the disease process, whereas the other targets multiple areas with the array being specific to the individual.
Biomedical
The biomedical model is limited to bodily issues and mainly focuses on identifying and treating specific pathologies. The treatment targets the cause, and in more severe illnesses, the approach also supports physiological processes and homeostasis, for example, in an intensive care unit.
This method allows the use of evidence-based routines and protocols, as the range of options is often quite narrow and, for most common situations, the evidence is readily available. Variance is expected but remains limited.
However, this applies only to common problems or processes. Specific investigations, such as a CT brain scan after a stroke, diagnostic algorithms, and treatment schedules, are all suitable for protocolisation.
Unfortunately, many people face more complex issues due to multiple diseases, long-term illnesses, or having a rare disease. These are not safely and effectively managed with protocols, although some aspects of their care, such as inserting a gastrostomy feeding tube, are handled using a standard operating procedure.
Biopsychosocial
The biopsychosocial approach typically suggests multiple factors that can be altered to improve function. Some will take time, some will depend on other interventions, and often their effectiveness is uncertain. Sometimes, two or three different treatments must be tried to succeed, and at other times, objectives need to be adjusted and new factors targeted. Evidence will guide the choice of interventions and inform how they are delivered.
People vary so much that sensible, evidence-based protocols are uncommon. The rehabilitative management of acute stroke is an exception, but even then, protocols become progressively less suitable after a few weeks.
One example is the Early Supported Stroke Discharge scheme. The original research necessarily had a protocol to ensure a consistent and uniform difference in management between two similar groups. However, it is irrational to impose, for example, a routine of two visits weekly for six weeks on everyone when some people would benefit from longer involvement at a lower intensity, others need less, and so on.
Conclusion
The contrast between biomedical and biopsychosocial healthcare approaches is evident. Yet, both operate within a single healthcare system, the NHS in the UK. Each country typically has just one system, mostly based on the biomedical model; thus, it is hardly surprising that the system faces challenges with specialities such as psychiatry, geriatrics, and rehabilitation.
The straightforward solution is for all healthcare systems to adopt the biopsychosocial approach, as it incorporates both biomedical and psychosocial aspects of healthcare. This would ensure continued attention to diagnosing and treating diseases while reducing the waste associated with overlooking the broader causes and factors that influence illness.
In the UK, and likely in most countries, this would emphasise the need for a fair and simple approach to social and long-term care needs, a substantial challenge but one that is more likely to be solved with a better model of healthcare.