The Relationship Between Need And Use Chap9

Question 1

Inverse care law

Answer 1

The observation that availability of care appears to be inversely related to need.

In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultations than in the healthiest area; and hospital doctors shoulder heavier case loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law: that availability of good medical care tends to vary inversely with the need of the population served.

This links in with the question on whether use reflect need.

Variables to look at is the use of health care with older population or in lower socio economic status. They will have higher need.

Question 2

Standardised Mortality Rate SMR

Answer 2

An indicator of the frequency of deaths in a population that takes into account the age and sex structure of the population.

Question 3

Systematic variations

Answer 3

Statistical differences that cannot be accounted for by the inevitable random variations that occur when counting events.

Question 4

How do you explain variations in utilisations?

Answer 4

1 Statistical factors:
• incomplete data – you need to make sure information on all cases under consideration is included (e.g. private sector data may not be included);
• random variation – observed differences may be due to chance.

2 Demand factors:
• age/sex composition – varies between populations;
• morbidity rate – frequency of the disease may vary;
• illness behaviour – varies with cultural attitudes and sociodemographic characteristics. 3 Supply factors:
• availability of services – number and distribution of facilities;
• professional judgement – varies between clinicians.

Note that the main reason for international variations in utilization rates is the availability of services. In addition morbidity rate, professional judgement and illness behaviour have some influence. Variations within a country are likely to be due to professional judgement and the availability of services.

Question 5

Utilisation varies because of 2 important social factors. Which ones?

Answer 5

It is known that use varies with at least two important social factors, age and socioeconomic status:

• age – health care is used more by elderly people and by infants. This can be seen in Figure 9.3, which shows how the level of health care expenditure varies with age in the Netherlands (Polder et al. 2002).
• socioeconomic status – health care is used more by less affluent people. This can be seen in all countries. In Catalonia, Spain, in 1994 this was observed both for ambulatory and hospital care (Borrell et al. 2001). Whereas 15% of men in the most affluent categories had visited a health care professional in the previous two weeks, 19.3% of the least affluent had. Similarly, the latter were more likely to have been hospitalized in the past year (8.8%) than the most affluent (6.1%).

Question 6

Cross-boundary flow

Answer 6

The use of services by people who are not resident in the local area of the facility.

Question 7

inverse care law

Answer 7

In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultations than in the healthiest area; and hospital doctors shoulder heavier case loads with less staff and equipment, more obsolete buildings and suffer recurrent crises in the availability of beds and replacement staff. These trends can be summed up as the inverse care law: that availability of good medical care tends to vary inversely with the need of the population served.