How health care

What is health needs assessment?

  Health needs assessment is a new phrase to describe the development and refinement of well established approaches to understanding the needs of a local population. In the 19th century, the first medical officers for health were responsible for assessing the needs of their local populations. More recently, in the 1970s the Resource Allocation Working Party assessed relative health needs on the basis of standardized mortality ratios and socioeconomic deprivation in different populations, and it used this formula to recommend fairer redistribution of health service resources.3 The 1992 Health of the Nation initiative was a government attempt to assess national health needs and determine priorities for improving health.4 Health needs assessment has come to mean an objective and valid method of tailoring health services—an evidence based approach to commissioning and planning health services.

 Although health needs assessments have traditionally been undertaken by public health professionals looking at their local population, these local health needs should be paramount to all health professionals. Hospitals and primary care teams should both aim to develop services to match the needs of their local populations. Combining population needs assessment with personal knowledge of patients’ needs may help to meet this goal.

   Why has needs assessment become important?

  The costs of health care are rising. Over the past 30 years, expenditure on health care has risen much faster than the cost increases reported in other sectors of the economy, and health care is now one of the largest sectors in most developed countries.6 Medical advances and demographic changes will continue the upward pressure on costs.7

At the same time, the resources available for health care are limited. Many people have inequitable access to adequate health care, and many governments are unable to provide such care universally. In addition, there is a large variation in availability and use of health care by geographical area and point of provision.8 Availability tends to be inversely related to the need of the population served.9

 Another force for change is consumerism. The expectations of members of the public have led to greater concerns about the quality of the services they receive—from access and equity to appropriateness and effectiveness.

 These factors have triggered reforms of health services in both developed and developing countries. In Britain, these reforms resulted in the separation of the responsibility for financing health care from its provision and in the establishment of a purchasing role for health authorities and general practitioners. Health authorities had greater opportunities to try to tailor local services to their own populations, and the 1990 National Health Service Act required health authorities to assess health needs of their populations and to use these assessments to set priorities to improve the health of their local population.10,11 This has been reinforced by more recent work on inequalities in health, suggesting that health authorities should undertake “equity audits” to determine if healthcare resources are being used in accordance with need.12

Health needs

  The World Health Organization’s definition of health is often used: “Health is a state of complete physical, psychological, and social wellbeing and not simply the absence of disease or infirmity.” A more romantic definition would be Freud’s: “Health is the ability to work and to love.”