This paper will discuss the broadening of the concept of health to include social and psychological concepts, as well as physical health, and the movement away from narrow conceptions of health and disease. In Europe and in USA, some specialties, particularly in psychiatry and cancer, have made considerable progress in the development of broader measurements of outcome in relation to health related quality of life. Others, such as cardiology and rheumatology have been more limited (concentrating on role functioning or return to work at most). Across all specialties, however, there has been an increasing interest in measuring outcome of health care in relation to the patient's quality of life.