Asadi-Lari Mohsen, Packham Chris, Gray David
Division of Cardiovascular Medicine, University Hospital, Nottingham, UK, NG7 2UH.
Health Qual Life Outcomes. 2003 Aug 21;1:34. doi: 10.1186/1477-7525-1-34.
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.
由于“需求”概念本身的复杂性,界定需求颇具难度,因此众多定义被提出也就不足为奇了。“健康”包含广泛的特征,所以“健康需求”应涵盖个人和社会护理、医疗保健、住宿、财务、教育、就业与休闲、交通及可达性。在备受政治关注的医疗保健领域,以目标为导向的标准似乎正在取代普遍提供和临床需求的概念;临床护理的这一重大变革值得对医疗保健结果进行重新评估。如果要充分且适当地利用稀缺资源,确定谁可能从这种新的医疗保健方法中受益同样重要。如果护理目标是“最佳健康”,成功的关键标志应该是确定个体患者的医疗保健需求(HCN)并据此调整服务。“需求”描述的广泛差异直接影响旨在满足人群医疗保健需求的政策和服务。因此,“需求”的定义对医疗保健提供具有重要影响——定义越严格,可获得的医疗保健就越少,反之亦然。本文描述了一些常见的需求定义,并讨论了它们在医疗保健提供方面各自的优缺点以及对健康政策的潜在影响。