Need for redefining needs

Health and Quality of Life Outcomes - 2003
Mohsen Asadi-Lari1, Chris Packham2, David Gray1
1Division of Cardiovascular Medicine, University Hospital, Nottingham, UK
2Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK

Tóm tắt

Defining needs is difficult due to the inherent complexity of the concept of 'need', so it is not surprising that numerous definitions have been proposed. 'Health' consists of a wide range of characteristics so 'health needs' ought to include personal and social care, health care, accommodation, finance, education, employment and leisure, transport and access. Target-driven standards in areas of health care with a high political profile appear to be replacing the concept of universal provision and clinical need; this major change in clinical care warrants a re-evaluation of health care outcomes. Identifying who might benefit from this new approach to health care is equally important if scarce resources are to be fully and appropriately utilised. If the goal of care is 'optimal health', the key marker of success ought to be to ascertain individual patients' health care needs (HCN) and tailor services accordingly. Wide variation in the description of 'needs' directly affects policies and services intended to meet a population's health care needs. Consequently, the definition of 'needs' has important implications for healthcare provision- the more constrained the definition, the less healthcare will be made available and vice versa. This paper describes some common definitions of needs and discusses their respective benefits and disadvantages in terms of health care provision and their potential impact on health policy.

Từ khóa


Tài liệu tham khảo

Jordan J, Wright J: Making sense of health needs assessment. British Journal of General Practice 1997, 47: 695–696.

An Introduction to HCNA; The epidemiological approach to health care needs assessment http://hcna.radcliffe-oxford.com/introframe.htm 2002., 2003:

Great Britain Resource Allocation Working Party: Sharing resources for health in England : report of the Resource Allocation Working Party. London, H.M.S.O. 1976.

Culyer A: Need--is a consensus possible? J Med Ethics 1998, 24: 77–80.

Davis MM: Medical care for tomorrow. New York, Harper 1955.

Bradshaw J: A taxonomy of social need. Problems and progress in medical care: essays on current research (Edited by: Mclachlan G). Oxford, Nuffield Provincial Hospital Trust 1972., 7th series:

Bradshaw J: The contextualisation and measurement of need: a social policy perspective. Researching the People's Health (Edited by: Popay J and Williams G). London, Routledge 1994.

Flew A: Wants or needs, choices or commands? Human needs and politics. (Edited by: Fitzgerald R). London, Pergamon Press 1977, 213–228.

Wiggins D, Dermen S: Needs, need, needing. J Med Ethics 1987, 13: 62–68.

Culyer AJ: Equity - some theory and its policy implications. J Med Ethics 2001, 27: 275–283. 10.1136/jme.27.4.275

Baldwin S: Needs assessment and community care: clinical practice and policy making. Oxford, Butterworth-Heinemann 1998.

Green LW, Kreuter MW: Health promotion planning: an educational and environmental approach. 2nd edition Edition CA: Mayfield, Mountain View 1991.

Doyal L, Gough I: A theory of human need. Hampshire and London, MacMillan Press Ltd. 1992.

NHSME: Assessing health care needs. London, National Health Service Management Executive 1991.

Stevens A, Gillam S: Needs assessment: from theory to practice. BMJ 1998, 316: 1448–1452.

Culyer AJ: Need and the National Health Service : economics and social choice. London, Martin Robertson 1976.

Gillam SJ: Assessing the health care needs of populations--the general practitioner's contribution. Br J Gen Pract 1992, 42: 404–405.

Culyer AJ, Wagstaff A: Equity and equality in health and health care. J Health Econ 1993, 12: 431–457. 10.1016/0167-6296(93)90004-X

James M: Towards an integrated needs and outcome framework. Health Policy 1999, 46: 165–177. 10.1016/S0168-8510(98)00064-5

Pickin C, St Leger S: Assessing health need using the life cycle framework. Buckingham, Open University Press 1993.

Brewin CR, Wing JK, Mangen SP, Brugha TS, MacCarthy B: Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment. Psychol Med 1987, 17: 971–981.

Buchan H, Gray M, Hill A, Coulter A: Needs assessment made simple. Health Serv J 1990, 100: 240–241.

DoH: The health of the nation : a strategy for health in England. London, Department of Health 1992.

Hawe P: Needs assessment must become more change-focused. Aust N Z J Public Health 1996, 20: 473–478.

Gray D, Hampton JR: Twenty years' experience of myocardial infarction: the value of a heart attack register. Br J Clin Pract 1993, 47: 292–295.

Payne N, Saul C: Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ 1997, 314: 257–261.

Black N, Langham S, Petticrew M: Coronary revascularisation: why do rates vary geographically in the UK? J Epidemiol Community Health 1995, 49: 408–412.

Cornell SJ, Chilcott JB, Brennan A: Is it feasible to plan secondary care services for coronary heart disease rationally? A quantified modelling approach for a UK Health Authority. J Epidemiol Community Health 2001, 55: 521–527. 10.1136/jech.55.7.521

Carstairs V, Morris R: Deprivation, mortality and resource allocation. Community Med 1989, 11: 364–372.

Rice N, Dixon P, Lloyd DC, Roberts D: Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis. BMJ 2000, 320: 284–288. 10.1136/bmj.320.7230.284

Gibson A, Asthana S, Brigham P, Moon G, Dicker J: Geographies of need and the new NHS: methodological issues in the definition and measurement of the health needs of local populations. Health Place 2002, 8: 47–60. 10.1016/S1353-8292(01)00035-1

Crown J: Needs assessment. Br J Hosp Med 1991, 46: 307–308.

Frankel S, Eachus J, Pearson N, Greenwood R, Chan P, Peters TJ, Donovan J, Smith GD, Dieppe P: Population requirement for primary hip-replacement surgery: a cross-sectional study. Lancet 1999, 353: 1304–1309. 10.1016/S0140-6736(98)06451-4

Stevens A, Gabbay J: Needs assessment needs assessment. Health Trends 1991, 23: 20–23.

Wilkin D: Patterns of referral: explaining variation. Hospital referrals (Edited by: Roland M and Coulter A). Oxford, Oxford University Press 1992.

McPherson K, Strong PM, Epstein A, Jones L: Regional variations in the use of common surgical procedures: within and between England and Wales, Canada and the United States of America. Soc Sci Med [A] 1981, 15: 273–288. 10.1016/0271-7123(81)90011-0

Ohmura J: Analysis of factors affecting the need and demand for medical care. Soc Sci Med 1978, 12: 485–496. 10.1016/0160-7979(78)90007-3

Morgan M, Mays N, Holland WW: Can hospital use be a measure of need for health care? J Epidemiol Community Health 1987, 41: 269–274.

Bowling A: Assessing health needs and measuring patient satisfaction. Nurs Times 1992, 88: 31–34.

Asadi-Lari M, Packham C, Gray D: Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services. Health Quality Life Outcomes 2003., 1: 26:

Tackling Health Inequalities - A Programme for Action London, DoH 2003.

Thông tin
Thông tin xuất bản

Health and Quality of Life Outcomes

Thông tin tác giả