Key points

• Health needs should be distinguished from the need forhealth-care, which is nowadays defined in terms of ability tobenefit.

• Health-care needs assessment is central to the planningprocess.

• There are three commonly contrasted approaches to needsassessment: corporate, comparative and epidemiological.

• Many toolkits and other resources have been developed to assistthose undertaking health-care needs assessments.

Theoretical perspectives

Health professionals spend much time learning to assess the needs ofindividuals; many know less about defining the needs of a population. Theneed for health underlies but does not wholly determine the need forhealth-care. Health-care needs are often measured in terms of demand, butdemand is to a great extent ‘supply-induced’ (see Chapter 7).For example, variations in general practice referral or consultation rateshave less to do with the health status of the populations served than withdifferences between doctors, such as their skills or referral thresholds[1].

There is no generally accepted definition of ‘need’.Last’s notion of the ‘clinical iceberg’ of disease [2](see Chapter 3) has been supported by various community studies indicatingmuch illness is unknown to health professionals. Needs can be classified interms of diseases, priority groups, geographical areas, services or using alifecycle approach (children/teenagers/adults/elderly). Bradshaw‘soften-quoted taxonomy highlighted four types of need [3]:

• expressed needs (needs expressed by action, for instance visiting a doctor);

• normative needs (defined by experts);

• comparative needs (comparing one group of people with another);

• felt needs (those needs people say they have).