8.1 The need/use/service provision dilemma

Three critical factors to consider in the planning and operation of an efficient health system are (1) the need for health services by the population, (2) the use of health services by the population, and (3) the provision of health services to the population. This object considers what each of these terms mean, how they might be measured, and why it is important to do so. Of particular importance is the interrelation between service need, use, and provision and the complexities involved in trying to measure each separately.

“Health needs are those that can benefit from health care or from wider social and environmental changes”

(Wright et al., 1998)

 

In the context of health care management, need can be defined in general terms as the requirement of a population for a given health service, determined by things like environmental factors, behaviour, or genetics. Some definitions of health care need discuss the ‘capacity to benefit’, suggesting that a given health care need only exists if effective interventions exist to address it (Wright et al., 1998). Indicators of need might be general, such as levels of mortality, morbidity, or deprivation in a population, or specific to a particular condition. Health care use relates simply to the levels of uptake of a given service by the population. Again, indicators of use might be general, such as the number of patients visiting a general practitioner for a given area and time period, or specific, such as the number of outpatients treated for a certain condition. The provision of health care relates to the availability of services. Importantly, provision should be assessed in relation to the population in question. A simple indicator of provision might be, for example, the number of doctors per 1000 people in a region. A more specific indicator might be, for example, the number of paediatric hospital beds per 1000 population aged under 15 (West and Lowe, 1976).

The measurement of need, use, and provision of health services is an essential requirement for effective health care management, and each has an explicitly spatial component of interest in a GIS context. When new services are introduced, or existing ones expanded or modified, it is intuitive that this new provision will be most beneficial if targeted at those populations with the greatest need. Equally, where services are to be removed or reduced, this will be least detrimental in those areas where need is least.

A fundamental complexity arises, however, when attempting to measure service need, use, and provision because the three are not independent. The need for a given service is determined partly by underlying environmental, behavioural, and genetic factors, but also by the success of existing health services in addressing the health problem in question. Thus the provision and use of health services partly determines need. Furthermore, the use of a given service is affected not only by the underlying need for that service but also by its provision. The provision of high quality services that can be easily accessed by the population is likely to result in an increase in use of that service, irrespective of the underlying need of the population. These interactions are summarised in the box below.

 

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