- noun something that is necessary or required
- plural noun something that a person must have for their health or well-being
- (written as Need)
Arguably the most used and the least properly comprehended word in discussions of health and health care. The meanings that attach to it are legion. Its persuasive power probably derives from a combination of two factors: one, the embodied implication that the entity asserted to be needed is actually necessary; the other, that this needed entity ought to be provided/received. To elucidate what any particular writer may be getting at, it is often helpful to ask what the thing said to be needed is needed for, and what the interests are of whoever is specifying that it is needed (given the ever present fact that whenever a professional is deciding what someone needs they are nearly always identifying a source of income for themselves). From this one might enquire as to whether there are other means than the one asserted to be needed - especially ones that may be more effective, or more cost-effective, and whether the person specifying the need is appropriately qualified (e.g. by training, accountability or responsibility). One may also enquire as to the social value, moral worth, etc. of the outcome for which the thing said to be needed is necessary (if it is necessary). In this way, some analytical content might be injected into what otherwise is in danger of being mere slogan-mongering.
It is invariably a good procedure to distinguish between a need for health and a need for health care (the latter may be seen as a kind of derived demand for the former).
Important and difficult issues remain concerning, for example, whether any particular need ought to be met and how much of it ought to be met. In prioritizing needs, economists naturally reach for the tools of cost-effectiveness and cost-utility analysis, which can indeed be helpful, not least in exposing the necessity for making social value judgments and interpersonal comparisons of health and illness.
The most frequently met practical measures of need at the commu nity level are morbidity and mortality data. They plainly imply a need for health though not necessarily a need for health care (which may not be effective in altering either for the better and, even if it is, may not be the most cost-effective general instrument available). Other concepts include capacity to benefit from health care (which is an outcome measure if the underlying thing needed is health care) and the resources that are necessary to reduce capacity to benefit to zero (i.e. to the point at which the marginal benefit falls to zero). There are manifest and formidable problems of measurement with both of these.
Need is often used as a criterion for adjusting the distribution of health care resources in the interests of fairness or equity. Again, its usefulness in this role would be much enhanced (in proportion to the reduction of its capacity to spread confusion and policy paralysis) if the questions suggested above are probed.