The Need And Demand For Healthcare Chap8 Flashcards
What are the different types of need?
felt need depends on the judgement of the individual. It is subjective, determined by the individual’s perceptions of their need for health. Measurement of the extent of felt need requires population surveys of self-assessed health.
Normative need depends on the judgement of professionals. Normative need varies over time and, as you have seen before, also with cultural context. The professional view is that to benefit from care there needs to be an effective intervention.
The third type of need is unfelt need. This depends on the existence of presymptomatic disease, which is not perceived by the individual.
In addition, there is the concept of relative need. This refers to the level of need of a population rather than a single individual. It is based on a simple comparison of the level of provision of a service in similar populations. If area A has more facilities than area B, the latter may be said to have a relative need. Such a judgement takes no account of whether or not the service in question is desirable (i.e. cost-effective) and should be provided anywhere.
Which concepts come into play with the notion of demand?
Felt need.
Illness behaviour – whether people take action to seek care depends on their perception of diseased status and cultural factors.
Supply of services – depends on two factors: the availability of facilities (buildings, staff, drugs, etc.) and the judgement of clinicians. The two are interrelated: if the number of beds in a hospital is doubled, the judgement of the clinicians may change such they now admit patients who previously were not admitted. In other words, the criteria that define normative need are altered.
is there a large proportion of disease that doesn’t receive formal care?
This question was addressed by John Last, an Australian doctor, in the early 1960s. He concluded that there was a ‘clinical iceberg’, as illustrated in Figure 8.2. It suggests that the major proportion of need lies submerged below the surface and is not presented to formal carers.
Layers of iceberg:
Top: demand for formal care
Bottom: demand for lay care, felt need but unexpressed, unfelt need, healthy.
Apart from a lack of clinical agreement, what explains the variations in clinical judgement?
- themselves (aspiration for income; enjoyment of their work; desire for approval from their peers)
- patients (using every conceivable treatment regardless of cost)
- third parties/society (keeping to cost-containment policies of their employers and those paying for care; avoidance of their perceived risk of litigation). I.e. We can’t afford to give out too many antibiotics.
A balance needs to be achieved between these 3 factors. Many healthcare problems boil down to a mismatch between these 3 factors.
What factors does healthcare depend on to be beneficial?
The ability of the population to benefit from health care depends on two things: the number of individuals affected, i.e. the incidence and prevalance of the condition under question, and the effectiveness of the services available to deal with it
Need, supply and demand
Need, demand and supply overlap. This means that there are eight potential fields including the external field where a potential service is not needed, demanded or supplied.
How to measure needs assessment?
(i) Waiting lists for surgery describe demand, which may be stimulated by supply, and which may or may not be needed (see Figure 8.4a).
(ii) Utilisation rates describe supply that may be either demanded, or needed, or both, or neither. Dental extractions, for example, may be performed for good clinical indications on people who prefer not to have them (a need not demanded), or at the patient’s request when there is no clinical indication (a demand not needed), or even unscrupulously for profit (supplied, but neither demanded nor needed) (see Figure 8.4b).
(iii) Even morbidity information may tell a variety of stories. Cancer registry information does not in itself clarify the need for the treatment of, say, bronchial carcinoma, which can entail services that cover every combination of need, supply and demand (see Figure 8.4c). For example, where pneumonectomy does not alter a patient’s prognosis, it is part of the supply that is not needed, but other forms of care, including preventive measures or continuing care, may confer benefit but be inadequately supplied, while others will still be demanded whether needed or not. Hence morbidity data do not clarify the need for health care, unless complemented by a detailed knowledge of the effectiveness of services.
The very difficult task of assessing health needs will be aided by a clear distinction between need, supply and demand. This is important because successful adjustments to health care delivery will depend on how far need, supply and demand are made congruent. This success will in turn ultimately depend on a focused epidemiological research programme, but in the short term much can be done with the available tools.
How would needs assessment based on felt need differ from one that focuses primarily on normative need? Think of potential conflicts between the views of professionals and of communities and the impact of both views on change of health services.
Coordinating different professions and organizations as well as consumer views can be difficult. It may well be that the different actors don’t take account of each other’s view. Where clinical medicine is involved in needs assessment, it may be more influenced by patients’ demand and the professional interests of doctors. An approach based on felt need would incorporate the views of consumers and communities, whereas a normative needs approach is based on professional views. Focus on felt need could make services more responsive to consumers’ needs. Emphasizing normative need is seen as less pertinent to change. For example, needs assessment may be used to justify existing services rather than to promote change.
Note that consumers and experts may have different priorities. What are the 2 models looking at this?
a) The functionalist model of change as described above – this tries to synthesize data and views from different sources, including consumers’ views, and gives managers the necessary information to shift resources.
b) The conflict model of change – this model focuses on consumers’ demands and builds on empowerment of communities to shift resources. Experts may participate in this process and address issues of normative need on behalf of the community but act within a consumer-defined framework.
Relative need
Comparison between needs of individuals with similar conditions or between needs of populations living in similar areas.
What is screening for?
It’s for people that have a normative need but not a felt need
