Health Services & Health Needs Assessment

• What are the 3 domains of action in public health?

  Health protection

  Health improvement

  Health services
• How is healthcare funded?

  Taxation & national government (e.g. NHS)

  Private health insurance (e.g. US)

  Social health insurance (e.g. Netherlands)
• What is scarcity?

  There are not enough resources for everyone

  Need to think about how to share out what we have
• What are the downfalls of a taxation funded health service?

  Health budgets are less predictable from year to year

  Government have to think about how to share out funds
• What are the downfalls of a private health insurance funded health service?

  Inverse care law -> those who need it most cannot get insurance -> barrier to health (health inequality)
• How does social health insurance funded healthcare work?

  Part of employees' salary goes towards health insurance (‘sickness funds’) & employers then match the money employees put in
• What is opportunity cost?

  The value of the consequences forgone by choosing to deploy resources in one way rather than in their best alternative use
• What is the WHO definition of health?

  Health is a state of complete physical, psychological, and social wellbeing and not simply the absence of disease or infirmity
• Why do health needs need to be assessed?

  Pressures on healthcare systems

  Health service resources are limited

  Inequitable access to existing care

  Effectiveness & quality of care
• How can we assess the needs of a community?

  Talk with community

  Records

  Surveys
• What is a health needs assessment?

  A systematic assessment of the health issues facing a population leading to agreed priorities & resource allocation that will improve health & reduce inequalities
• What is the aim of a Health Needs Assessment?

  Identify health problems in a population & detect differences within and between groups -> Determine health priorities and unmet need

  What should be done, what can be done and what can be afforded
• What is the triangle of Health Needs Assessment?

  Incidence & prevalence (burden of disease)

  Effectiveness & cost-effectiveness

  Existing services
• What are the elements of a Health Needs Assessment?

  Epidemiological -> by time, place, person

  Comparative -> here vs there

  Corporate -> people, providers, purchasers
• What is assessed in a Health Needs Assessment?

  Problems -> determinants, RFs, diseases etc.

  Services -> prevention, social care, treatment etc.

  Community/social experience -> community, crime, engagement
• What are the 5 objectives of a Health Needs Assessment?

  Planning

  Intelligence

  Equity

  Target efficiency

  Involvement of stakeholders
• Framework of Qs to consider when assessing health needs?

  What is the problem?

  Size and nature of the problem? (time, place and person: Who? When? Where?)

  What has caused the problem?

  What are the current services?

  What do people (professionals, patients, public, management, policymakers and others) want?

  What are the most appropriate and cost effective solutions?

  What are the resource implications on healthcare or other services?

  How might the resource be implemented?

  What are the outcomes to evaluate change and measure success?
• What are the 5 steps to Health Needs Assessment?

  Defining the population & setting objectives

  Identifying health priorities by collecting & analysing data

  Assessing & agreeing a health priority

  Planning for change

  Evaluate
• What is economic evaluation?

  Comparative analysis of alternative courses of action in terms of costs and consequences

  Types:

  • cost-effectiveness
  • cost-utility (consequences measured in QALYs)
  • cost-benefit (costs & consequences measured in monetary units)
• What is the health triangle?

  Analytical tool that can be used to identify potential health issues for the population

  Can help review associations between factors

  
• Health needs assessments need to be done regularly as things change.