Need and decision making in dentistry--an economic perspective.

The issue of alternative definitions of need has recently received attention in the dental literature. However, a number of important questions have gone unanswered. Why is it necessary to assess needs; who is to do the assessing and in what decision making contexts are needs to be assessed? This paper presents an economic rationale for assessing needs. Scarcity necessitates choices as to how resources will be used, and it is only by identifying needs and the costs of meeting them that such choices can be made rationally and explicitly. Three levels of decision making are distinguished, together with three assessors of need: patients, dentists and society. It is argued that decisions to seek care and to comply with professional instructions will ultimately rest with patients, whereas decisions as to which individual patients should be given treatment of what type will inevitably lie with the dental profession. In the latter case it is particularly important that dentists' judgements should reflect the social context of their decision making. At a wider community level, it is suggested that dental care professionals have a major role to play in assessing the potential for improvements in the oral health of the population, while the task of making societal decisions as to which needs ought to be met is essentially that of policy makers. Once the legitimate roles of various parties in assessing needs in different decision settings have been established, the concept of need has a key contribution to make to the planning and provision of dental care services.