Intended for healthcare professionals

Education And Debate Health needs assessment

Needs assessment: from theory to practice

BMJ 1998; 316 doi: (Published 09 May 1998) Cite this as: BMJ 1998;316:1448
  1. Andrew Stevens, professor of public healtha,
  2. Stephen Gillam, director, primary care programmeb
  1. a Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
  2. b King's Fund, London W1M 0AN
  1. Correspondence to: Professor Stevens

    This is the third in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively

    The purpose of needs assessment in health care is to gather the information required to bring about change beneficial to the health of the population. It is generally, but not universally, accepted that this takes place within the context of finite resources.1 “Health gain” can therefore be achieved by reallocating resources as a result of identifying four factors:

    • Non-recipients of beneficial healthcare interventions (that is, unmet need);

    • Recipients of ineffective health care (and releasing the resources for unmet need);

    • Recipients of inefficient health care (and releasing resources for unmet need); and

    • Recipients of inappropriate health care (for whom the outcomes could be improved).

    The subjects of healthcare needs assessment are the populations and patients who are recipients or potential beneficiaries of health care. Populations, of course, include individual patients. The assessment of individuals' needs may form part of the assessment of a population's needs, but it may be costly and it risks ignoring individuals with needs who do not present themselves for health care. Table 1 shows the circumstances favouring individual needs assessment for planning purposes.

    View this table:
    Table 1

    Factors determining basis for assessing healthcare needs

    The priority attached to different needs, whether of populations or of individuals, raises philosophical problems. For example, should the principal criterion be the benefit that could potentially be obtained for each individual, or the severity of their presenting condition?2 In other words, should greater priority (a greater assessed need) be attributed to the need for surgery of a patient with early stage colorectal cancer or to the need for hospice care of a terminally ill lung cancer patient? In practice the former, the approach that favours the greater …

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