McMaster University, Hamilton, Ontario, Canada.
J Eval Clin Pract. 2013 Dec;19(6):1054-9. doi: 10.1111/jep.12026. Epub 2013 Mar 22.
RATIONALE, AIMS AND OBJECTIVES: Allocating resources on the basis of population need is a health care policy goal in many countries. Thus, resources must be allocated in accordance with need if stakeholders are to achieve policy goals. Small area methods have been presented as a means for revealing important information that can assist stakeholders in meeting policy goals. The purpose of this review is to examine the extent to which small area methods provide information relevant to meeting the goals of a needs-based health care policy.
We present a conceptual framework explaining the terms 'demand', 'need', 'use' and 'supply', as commonly used in the literature. We critically review the literature on small area methods through the lens of this framework.
'Use' cannot be used as a proxy or surrogate of 'need'. Thus, if the goal of health care policy is to provide equal access for equal need, then traditional small area methods are inadequate because they measure small area variations in use of services in different populations, independent of the levels of need in those populations.
Small area methods can be modified by incorporating direct measures of relative population need from population health surveys or by adjusting population size for levels of health risks in populations such as the prevalence of smoking and low birth weight. This might improve what can be learned from studies employing small area methods if they are to inform needs-based health care policies.
背景、目的和目标：在许多国家，根据人口需求分配资源是医疗保健政策的目标之一。因此，如果利益相关者要实现政策目标，就必须根据需求分配资源。小区域方法被提出作为一种揭示重要信息的手段，可以帮助利益相关者实现政策目标。本综述的目的是考察小区域方法在多大程度上提供了与满足基于需求的医疗保健政策目标相关的信息。
我们提出了一个概念框架，解释了文献中常用的术语“需求”、“需要”、“使用”和“供应”。我们通过该框架批判性地回顾了小区域方法的文献。
“使用”不能作为“需要”的代理或替代物。因此，如果医疗保健政策的目标是为平等需求提供平等机会，那么传统的小区域方法是不充分的，因为它们衡量不同人群中服务使用的小区域差异，而不考虑这些人群中的需求水平。
可以通过从人口健康调查中纳入相对人口需求的直接衡量标准，或者通过调整人口规模以适应人群中的健康风险水平（如吸烟流行率和低出生体重）来修改小区域方法。如果小区域方法要为基于需求的医疗保健政策提供信息，那么这可能会提高从这些研究中获得的信息。
