identify new target populations that demonstrate unmet need

Science, Ideology, and Health Care


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James D. Harrison, Jane M. Young, Phyllis N. Butow,

and Michael J. Solomon

Need is a pivotal concept within health systems internationally given its

driving force in health care policy, development, and delivery at population

and individual levels. Needs assessments are critical activities undertaken

to ensure that health services continue to be needed and to identify new

target populations that demonstrate unmet need. The concept of need is

underpinned by varied theoretical definitions originating from various disci-

plines. However, when needs are assessed, or health interventions developed

based on need, little, if any, detail of the theoretical or conceptual basis of

what is being measured is ever articulated. This is potentially problematic and

may lead to measurement being invalid and planned health services being

ineffective in meeting needs. Seldom are theoretical definitions of need ever

compared and contrasted. This critical review is intended to fill this gap in

the literature. Interpretations of the concept of need drawing from areas such

as psychology, social policy, and health are introduced. The concept and

relevance of unmet need for health services are discussed. It is intended that

these definitions can be used to operationalize the term “need” in practice,

theoretically drive needs assessment, and help guide health care decisions

that are based upon need.

One of the primary goals of health care systems internationally is to provide

good health care based on need (1�3). It is need that drives government, clinicians,

policymakers, health managers, public health practitioners, and health service

researchers to develop and provide effective, relevant health care services.

Attempts are made to meet population and individual needs through a hybrid of

initiatives, which seek to create the best experience and the best possible outcomes

International Journal of Health Services, Volume 43, Number 3, Pages 567–585, 2013

© 2013, Baywood Publishing Co., Inc.




for those who use the myriad of health services and interventions available to

meet health care need.

At a most basic level, need triggers the delivery of health care when a clini-

cian assesses an individual patient’s need for care before prescribing treatment.

Responding to individual patient need, however, is not the sole process of health

care needs assessment (4). Needs assessments are also undertaken periodically to

appraise whether health services and their activities continue to be needed. These

exercises validate current populations targeted for services and identify new target

populations that report unmet need (5). From a public health perspective, needs

assessment provides empirical data to define, refine, or redefine public health and

health service objectives and goals, leading to potential improvements in health

and well-being (5). From a health service management perspective, identification

of health consumers’ need for health services can provide impetus for health

service modification that has the potential to improve patients’ perceived quality

of care (6). Health needs assessment is also used to prioritize resource allocation,

whether that means financial, workforce, equipment, or facility investment in

individuals or populations where there is most need (7). This particular aspect of

health needs assessment is becoming increasingly important in this era of finite

financial resources, which is increasingly pressured by aging populations and

expanding, costly advances in medical technology.

Given the role of need and needs assessment in health care systems, it is not

surprising these are pivotal concepts that feature internationally within health and

cancer care policy. Health system performances are now benchmarked against

their responsiveness to individual and population health care need (8, 9). Ensuring

that individual and population health needs are met is a central policy objective

to delivering patient-centered health services. Patient-centered care has been

described as care that is respectful of, and responsive to, individual patient

preferences, values, and needs (3, 10). A more recent development in the need

debate has been the introduction of the concept of unmet need (4).

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