Measuring the need for primary health care: an index of relative disadvantage

摘要

The prime objective of primary health care provision is the maintenance or improvement of the population's health. The equitable distribution of resources is paramount to this and measures of disadvantage are implemented to assess differential levels of need as a basis for calculating deprivation payments according to general practitioner workload. Despite research that highlights the benefits of measures of social disadvantage, indices have not been used to fundamentally shape resource allocation for health authorities. This paper uses the results from a patient survey into utilization behaviour to define and model the determinants of the need for health care based on components of relative need and accessibility. Proxy indicators are derived from routine sources of data to create an Index of Relative Disadvantage (IRD). A sensitivity analysis confirms the robustness of the index and shows that--although the index employs a wider range of variables than most previous deprivation indices--there is no gross data redundancy. Simplified versions of the index are also explored and evaluated. The IRD developed here is closely correlated with other indices of disadvantage, but its greater breadth and more logical construction mean that it may be more likely to be a more widely applicable instrument for health care planning of resource allocation.