Health Need assessment

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Health Need assessment

• 17.9.2007
• Grete Botten

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The goal of the course

• Exploring the demographical and epidemiological
  changes of health problems and diseases (medical
  needs)
• Epidemiological changes will be related to the
  political, social and economic situation for
  various population groups (gender and age,
  socio-economy, ethnicity, etc) and in different
  countries and priority questions
• Demographical and epidemiological data will be
  used to assess future need for health care in
  different settings

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Learning objectives

• Be familiar with demographic terms, trends and
  projections
• Be able to find and use vital statistics in
  planning health services
• Know basic epidemiological concepts and be able
  to use them in order to perform need assessment
• Be able to identify epidemiological changes
  globally and to present evidence as to why this
  changes have happened
• Be able to interpret trends and use techniques to
  make projections to estimate need for future
  health care services
• See the relationship between the concepts need,
  demand and supply
• Relate need to priority and effectiveness
• Use need assessment as basis for resource
  allocation

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What is Health Needs Assessment (HNA)?
A systematic method of identifying unmet health
and healthcare needs of a population, and making
changes to meet those unmet needs The objective
is to Specify services that will improve the
health of the population
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Central concepts related to health need
assessment

• Needs
• Demand
• Supply
• Efficiency
• Priority

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Health Needs Assessment

• Used for service planning, monitoring/
  evaluation, responding to changing needs
• Internal market/commissioning (like England)
• Three approaches to HNA have been suggested
• - Epidemiological (focus in this course)
• - Corporate
• - Comparative

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The idea of need assessment

• Health services may be based on two opposite
  ideologies
• Based on planning within a public ownership
• Based on market and competition
• Within a planned service without market
  mechanism, facilities and capacity should meet
  the need of the population
• Need assessment relevant for planning the
  services (within budget)
• Need assessment relevant for the purchaser in in
  a provider/purchaser split model
• Within a competitive market services will develop
  in response to the demand
• Need assessment relevant for the owners, as they
  need to know the market situation

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What is included in Health Needs Assessment?

• Defining disease and services
• Know the prevalence of diseases
• Know the number that should be served
• Know the medical guidelines for examination and
  treatment - state of the art
• Know the services available and their cost

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How should need be defined?

• Medical definition
• Linked to diagnosis
• Linked to guidelines for examination and
  treatment/care
• Often expressed as the optimal, no resource
  limitations
• Lay people/patient defined
• Linked to suffering
• Linked to human/patients right
• Management defined
• Linked to resources and the contract
• Politically defined
• Linked to patients rights
• Linked to resources
• Linked to priority

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The entire population
Person with a health problem
N E E D ?
Seeks health care
Get an examination of a GP and treatment and
follow up
Is referred to specialist health care/hospital
Get further examinations and treatment
Is followed up by various professionals/GP
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Need for health care

• A medical concept refecting
• Need is supposed to be linked to objective
  prevalence of disease/illness and the existing
  state of the art examinations, for treatment
  and care
• Need is related to measures for a population that
  reduces their risk for becoming ill
• Need is thereby defined according to criteria
  given by health professional
• But
• Need links to the process of being diagnosed/not
  diagnosed, based on symptoms, complains and
  questions about being sick
• Need is closely inked to possibilities and
  expectations and links to medical and lay
  peoples culture and beliefs
• Need has a political dimension and is linked to
  priority
• Within public health the political dimension is
  most evident
• Saying that
• Need is not (only) objective and globally equal
  for the equal diseases/patients or populations

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Relation between medical and lay peoples need
conncept
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(No Transcript)
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Unmet needs essential to identify

• Identifying unmet need requires a public health
  focus which includes those not getting/seeking
  services
• Need large surveys to identify those not
  identified through the health services
• The relationship between
• needs (unidentified, unmet, and met)
• services (appropriate and inappropriate)

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Factors that will influence need for health care
in a population

• Demographic changes
• New technology (both increase and reduce demand)
• Prevention like vaccination, less smoking (public
  health measures).
• Identification of risk factors and possibility
  for reduction (need assessment in itself)
• New knowledge and changing attitudes

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Demand for health care

• An economic concepts, reflecting
• The percieved need for services
• Population
• Patients
• Health personell (throug their referrals )
• The willingness (ability) to pay for the services
• Services are unlikely to be paid directly
• Asymmetric information.
• What influences demand?

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Supply of health care

• An economic concepts, reflecting
• What services are offered (in the market)
• The price of those services
• Often unknown both for buyer and seller, at
  least in a public system
• What will influence supply

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Need, demand and supply - summary

• Need (medical) relates to the prevalence of a
  disease what people might benefit from and the
  number of people with a need
• Demand relates to what is actually asked for in a
  market expressed need
• Any difference between them is unmet need
• Supply relates to which services are offered in
  the marked
• Met need is the services the population actually
  gets
• However
• Need at the political/policy level relates to
  priority and efficiency

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NEED
DEMAND
SUPPLY
More details in Stevens
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• In a perfect situation need, demand and supply
  would be equal
• Need may exceed demand
• Demand may exceed need (as it is medically
  defined and prioritized)
• Supply may be less than demand (and need)
  resulting in regulation/rationing and queuing
• May supply be higher than demand?? Unstable
  situation

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Different scales/levels of HNA

• National level
• Regional level/County level
• Municipality level
• Community
• GP/clinical level

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National level

• Relevant for
• National strategies to improve the services for
  eg
• Specific/defined patient group
• Build new facilities
• Public health activities eg
• Legislation
• Vaccination program (influenza)
• Reduce inequity eg
• Assess the unmet need in various groups (based on
  diagnosis or social criteria)
• Monitoring the situation / evaluation
• Allocate resources according to needs
• On national level important question
• Do all geographical areas get equal amount of
  resources, related to their population (need)?
• Do all population/patient groups get equal access
  to the health services as response to their need

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Regional/county level

• Need assessment relevant when
• services are delivered at the regional level
  (provider)
• public health programs aim at reaching a regional
  population
• The same questions as at national level

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Local municipality/community level

• In a provider/purchaser split model (know what to
  buy)
• Planning necessary services for the local
  population/various patient groups
• Hire health personnel to cover the need of the
  population, eg. in a patient list system, for
  nursing homes etc
• For offering local private services

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Focus i HNA

• Individual need or populations need?
• Focus is populations need (as a sum of the
  individual needs)
• Public health has per see a population approach
• Specific diagnosis or relevant services?
• Focus is on need for services more that diagnosis
  
• Different medical diagnoses may need the same
  services
• The past, present or future?
• Focus is on the future (developing services for
  the number of people in the future)
• Implement public health measures that reduces
  health problems in the future

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Health Needs Assessment

• Used for service planning, monitoring/
  evaluation, responding to changing needs
• Internal market/commissioning
• Three approaches to HNA have been suggested
• - Epidemiological
• - Corporate
• - Comparative

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Epidemiological approach

• Statement of the problem
• Subcategories (i.e. type 1, type 2 and
  gestational diabetes severity categories for
  dementia)
• Prevalence and incidence
• Services available and their costs
• Effectiveness and cost-effectiveness of services
• Quantified models of care and recommendations
• Outcome measures, audit methods and targets
• Information and research requirements

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Components in an epidemiological approach to HNA

• Defining the problem and objectives
• Define the population
• Prevalence and incidence of the actual health
  problem (in relation to treatment possibilities,
  not etiology)
• Number intended to be covered/treated
• Models and guidelines for treatment
• Available services, their cost and their
  cost-effectiveness
• Recommendation
• Model for future evaluation
• Research requirement

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Corporate Approach

• Based on the demands, wishes and perspectives of
  interested parties - professional, political and
  public views
• Blurs difference between need and demand, and
  between science and vested interest
• Encouraged by the 1989 reforms with its local
  voices and current emphasis on partnership and
  collaboration and public involvement
• Essential if policies are to be sensitive to
  local circumstances

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Comparative approach

• Contrasts the services received in one area with
  those elsewhere
• Should take into account local population
  characteristics (demography, mortality, morbidity)

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Methodological aspects

• Approaches to Health Need Assessment
• Population perspective
• Use indicators that may express need (suurogates
  may be valuable)
• Types and sources of data (vital statistics,
  demography mm)
• Analysing and interpreting the data
• Conclusions

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Existing services
Effectiveness/ Cost/effectiveness
The future services
Incidence/prevalence of disease Number of people
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Illustration how need may be developing in a
population
Need
The supply
Time
2015
2005
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Table 3 in Stevens - etc.

• The concepts Efficacy/effectiveness
• Size of effect (scaled)
• Quality of evidence about effectiveness
• Several RCTs
• One RCT
• Clinical intervention trial (non RCT)
• Uncontrolled experiments
• Opinion based on experience
• Non evidence

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Methodological problems related to

• Inadequate date on incidence/prevalence
• Inadequate date on effectiveness and
  cost/effectiveness
• Lack of agreement on threshold for intervention
• Heterogeneous patient group
• Treatment complex and often several possibilities

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Role of need assessment i NHS

• Health services is bought on behalf of a
  population
• Populations ability to benefit from health care
  must be included
• A balance between enough information and not too
  many details

• Health care needs of a defined population
• Appraisel of service options for meeting the
  needs
• Specification of pattern of service provision
• Choosing providers
• Contracts

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Summary

• Need will be defined and discussed in a medical
  context, both within care and public health
• Demograpfy must to be taken into consideration, a
  population approach
• In four cases you will apply such need data and
  relate them to reality in different settings
• Use of need indicator as basis for resource
  allocation will be discussed in a last lecture