Concept Of Need Research Articles

Evaluating fuel poverty policy in Northern Ireland using a geographic approach

Recent audits have shown that anti-fuel poverty policies in the UK depend on loosely defined targeting and cannot accurately identify fuel poor households. New methods of targeting are necessary to improve fuel poverty policy. This paper uses Geographic Information System (GIS) techniques to evaluate the targeting of a home energy efficiency scheme small area level in Northern Ireland, based on the level of need. The concept of need is modelled using an area-based, multi-dimensional fuel poverty risk index. The characteristics and spatial distribution of household retrofits are explored. Policy activity and expenditure are compared with the level of need in an area. Results indicate that policy activity is only weakly associated with the level of need in an area, although policy appears to be well targeted in a few areas. Contrary to existing evidence, rural areas appear to be well served by policy, receiving above average numbers of retrofits and expenditure. There are typically two types of retrofit (major and minor). Most retrofits are minor and may not reduce fuel poverty. These results evidence the limitations of the current targeting system and suggest that there may be scope for improved policy implemented via a more proactive, area-based approach.

Needs in Health Care: What Beast is That?

Need is a pivotal concept within health systems internationally given its driving force in health care policy, development, and delivery at population and individual levels. Needs assessments are critical activities undertaken to ensure that health services continue to be needed and to identify new target populations that demonstrate unmet need. The concept of need is underpinned by varied theoretical definitions originating from various disciplines. However, when needs are assessed, or health interventions developed based on need, little, if any, detail of the theoretical or conceptual basis of what is being measured is ever articulated. This is potentially problematic and may lead to measurement being invalid and planned health services being ineffective in meeting needs. Seldom are theoretical definitions of need ever compared and contrasted. This critical review is intended to fill this gap in the literature. Interpretations of the concept of need drawing from areas such as psychology, social policy, and health are introduced. The concept and relevance of unmet need for health services are discussed. It is intended that these definitions can be used to operationalize the term "need" in practice, theoretically drive needs assessment, and help guide health care decisions that are based upon need.

From Needs to Health Care Needs

One generally considered plausible way to allocate resources in health care is according to people's needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything.

Should There Be a Female Age Limit on Public Funding for Assisted Reproductive Technology?

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice-the capacity to benefit, personal responsibility, and need-to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice.

Comment on: "Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply"

As pointed out by Lorenzo Oliveira et al., the primary role of a blood center is the provision of a safe, economical and adequate blood supply(1). However, different factors govern the provision and the use of blood. An adequate supply of blood is based upon the availability of willing donors, while its usage depends upon medical need. It is clear that the concept of need only stimulates donors when dramatic circumstances such as natural disasters occur. It is frequently the case that modern disasters do not actually need a great deal of blood and indeed, the generosity of donors may be wasted. In view of this, a more effective system of communication and blood resource sharing in emergency situations has been developed in the United States. However, it is well-recognized that seasonal variation in the supply of blood is a pervasive problem. In the USA, there are times of the year when local or national appeals for blood donors may well be anticipated - for example during the summer or the Christmas/New Year holiday season. Careful inspection of Figure 1 shows the general reduction in collections during the middle part of the year (summer in the Northern hemisphere). Less apparent is the fact that the demographic structure of the donor population changes seasonally, unexpectedly affecting (for example) the prevalence if infectious disease markers. We have noted more first-time donors in the summer, and as might be expected, fewer donors in schools and colleges. This is, to a large extent, a consequence of the practice of collecting blood in locations away from the blood center itself, along with an increasing focus on younger blood donors. Figure 1 Blood collections by week, American Red Cross. Week 1 starts on the first Sunday in the calendar year: weeks zero and 52 may therefore be truncated. Certainly in the USA, a great deal of effort is put into recruitment of donors and such efforts are managed in the context of awareness of the drivers of blood shortages. Consequently, analysis of the number of blood units collected does not tell us as much as we may anticipate, because the data are a result of more or less successful efforts to overcome predictable shortages. Nevertheless, prompted by the accompanying paper, we analyzed weekly blood collection data for the American Red Cross, which collects about 40% of the 14 million blood donations in the USA (Figure 1). Clearly evident are repeated decrements around Weeks 21-22 (end of May), 26-27 (early July), 34-36 (beginning of September) and 46-47 (mid-late November). Also, as might be expected, there is a decline in the first and last weeks of the year, although it should be noted that the analysis is based upon each week starting on a Sunday, so the steep decline for week 52 is, in part, an artefact due to the truncation of this 'week'. The periods noted correspond to national holiday periods: Memorial Day, Independence Day, Labor Day, Thanksgiving and Christmas/New Year, respectively. Memorial and Labor days are held on a Monday, Independence Day is always July 4th (but observed on a weekday if falling on the weekend) and Thanksgiving is the fourth Thursday in November (many individuals are also on leave the following Friday). There are other holidays within the year, but they do not enjoy universal celebration, so do not clearly impact the collection data. On the whole, it is evident that blood collection organizations can adjust to predictable reductions in collections, but some logistic difficulties will be apparent for platelets, with a 5-day shelf-life. However, modeling studies suggest that unexpected surges in blood use, or shortages due to severe weather, an outbreak of influenza, etc. may have severe impacts upon blood availability. Where feasible, such events may be ameliorated by carefully organized resource sharing - that is, blood components may be shopped from locations that are less affected. However, in the absence of such mechanisms, local plans for donor mobilization should be developed and in place as part of emergency planning.

Why Need is “A Word We Cannot Do Without” in Economics

Economists in the neoclassical tradition do their best to avoid using the word “need.” Social economists have traditionally been more open to discussions of need. Philosophic discussions of need are also scarce but nevertheless helpful. This essay will argue that need is “a word we cannot do without” in economics, and not only in social economics. Need is objective, satiable, and absolute, by contrast with want or preference as it is defined in neoclassical economics. With this clarification, 1) it is reasonable that public policy should consider need as well as want and aim to satisfy some needs, and 2) for some purposes, such as the economics of health care, conventional demand cannot be understood without the concept of need. Thus, even the narrower purposes of neoclassical economics cannot be achieved without clarifying and using the concept of need, in addition to the more usual motivational assumptions of neoclassical economics.

The value and limits of rights: a reply

I reply to each of the contributions in this issue. I agree with much that Hillel Steiner argues, especially his insistence that the associated ideas of impartiality and discontinuity are crucial to dealing satisfactorily with a diversity of competing claims. I am, however, less willing to conceive provision for that diversity as the role, rather than a role, that we should ascribe to rights. I question the success of David Miller’s endeavour to provide a unified justification of human rights grounded in the concept of need. It is the notion of a minimally decent human life, rather than need itself, that does most of the justificatory work in Miller’s argument and, arguably, that notion does not deliver a genuinely unitary account of human rights. I concede the case for state funding of opera and the arts more generally to John Horton’s argument, but defend neutralism, and its associated distinction between the right and the good, as a strategy for dealing with diversity, including cultural diversity. I resist Richard Bellamy’s attempt to ground all basic rights in democracy and suggest that his argument relies upon idealized assumptions about the functioning of democracy. I share much of his objection to substituting judicial for political decision-making but argue that a strong moral commitment to rights need not imply a shift in power from democratic processes to courts. I endorse Albert Weale’s argument for favouring a beneficial design approach over a rights approach to healthcare and to many other social goods. Rights should not monopolize our moral and political thinking.

Need for recovery from work and sleep-related complaints among nursing professionals

The concept of need for recovery from work (NFR) was deduced from the effort recuperation model. In this model work produces costs in terms of effort during the working day. When there is enough time and possibilities to recuperate, a worker will arrive at the next working day with no residual symptoms of previous effort. NFR evaluates work characteristics such as psychosocial demands, professional work hours or schedules. However, sleep may be an important part of the recovery process. The aim of the study was to test the association between sleep-related complaints and NFR. A cross-sectional study was carried out at three hospitals. All females nursing professionals engaged in assistance to patients were invited to participate (N = 1,307). Participants answered a questionnaire that included four sleep-related complaints (insomnia, unsatisfactory sleep, sleepiness during work hours and insufficient sleep), work characteristics and NRF scale. Binomial logistic regression analysis showed that all sleep-related complaints are associated with a high need for recovery from work. Those who reported insufficient sleep showed a greater chance of high need for recovery; OR=2.730 (CI 95% 2.074 - 3.593). These results corroborate the hypothesis that sleep is an important aspect of the recovery process and, therefore, should be thoroughly investigated.

Does respite care address the needs of palliative care service users and carers? An exploration of their perspectives and experience of respite care

IntroductionThere are clear indications that over the coming years, an increasing amount of support for carers of patients with palliative care needs will be required. In recent UK policy and...

Hegel’s notion of natural purpose

This paper argues that the notion of natural purpose developed by Hegel can only be thoroughly grasped by considering its intimate connection with the idea of contradiction and, particularly, with what Hegel in his philosophy of nature called the ‘activity of deficiency’. This expression is used by Hegel to denote the ontological situation of every living being, which is embodied most authentically in the concepts of need and drive. For Hegel, life itself is imbued with contradiction because it is inextricably bound up with what it lacks: its identity is at one with its negation. This paper defends the thesis that Hegel’s philosophy—and not just his philosophy of nature—can be characterized as an ‘ontology of life’ (to use the same expression that Martin Heidegger applied to Aristotle’s De Anima), or more precisely, as an ontology of living individuality.

An Experimental Comparison of Two Perspectives on the Concept of Need for Orientation in Agenda-Setting Theory

Need for orientation (NFO) is a key contingent condition for agenda-setting effects. Traditionally, this concept has been measured by two lower-order components, but a recent reconceptualization expanded it to three dimensions. The current experimental study tested how comparable the traditional and new NFO scales are, and how strongly they predict agenda setting. Findings indicate that both NFO scales are (1) reliable tools for predicting first-level agenda-setting effects, and (2) significantly correlated with each other. The question whether or not the new NFO scale predicts second-level agenda-setting effects, however, needs further exploration.

Engendering care: HIV, humanitarian assistance in Africa and the reproduction of gender stereotypes

This paper draws upon recent research in Durban, South Africa to unravel the complexities of care ethics in the context of humanitarian aid. It investigates how the gendering of care shapes the provision of aid in the context of the HIV in Africa constructing an image of ‘virile’ and ‘violent’ African masculinity. Humanitarian organisations construct imagined relations of caring, invoking notions of a shared humanity as informing the imperative to facilitate change. This paper draws on varied examples of research and NGO activity to illustrate how these relations of care are strongly gendered. Humanitarian interventions that invoke universalising conceptions of need could instead draw on feminist care ethics that seeks to balance rights, justice and care in ways that attend to the webs of relationships through which specific lived realities are shaped. Essentialising feminised discourses on care result in a skewed analysis of international crises that invariably construct women (and children) as victims in need of care, which at best ignore the lived experiences of men and, at worst, cast men as virile and violent vectors of disease and social disorder.

Music Therapy and Eating Disorders- A Single Case Study about the Sound of Human Needs

In this article, I reflect on a music therapy intervention realized many years ago, with a young woman who had the diagnosis of Bulimia Nervosa. The concepts to which I will refer are the concept of resource orientated psychotherapy and the Bernese concept of need adapted -and motivational attunement (Grawe, 1998; Grawe and Grawe-Gerber, 1999; Stucki and Grawe, 2007). I re-viewed one of my cases, Ms. H., following some of the ideas developed by the authors. I discovered various moments of interest, which made me think in terms of a Need Adapted Music Therapy process. Therefore, in the presentation of the case, besides talking about the patient’s eating disorder I want to point out her basic needs and how she demanded for them to be met symbolically during shared improvisational moments with the music therapist. And even if the therapist did not have the mentioned concepts in her mind at the time, it seems as if patient and therapist met quite often in this kind of “silent space of needs”.

The conceptualization and measurement of need: a key to guiding policy and practice in children's services

ABSTRACTEffective services for children must be grounded in the sound conceptualization and measurement of need. The concept of need is often misunderstood because it is used in different ways. Defining need as both a requisite and a goal is desirable. The conceptualization ought to rest on an acceptance that not only are objective and universal needs to attain physical health and autonomy requirements for all human beings, but subjective needs may also sit alongside of universal needs. The ecological/developmental perspective is best suited as a framework for assessing the needs of children. One of its tenets, the importance of understanding the interaction of risk and protective factors, is highly relevant to assessing needs. An assessment of the interaction of risk and protective factors operating in a child's life reveals the requisites and goals necessary for child development. The proposed approaches to the conceptualization and measurement of need when combined will be conducive to better assessment and intervention by social workers with children.

Simple versus composite indicators of socioeconomic status in resource allocation formulae: the case of the district resource allocation formula in Malawi

BackgroundThe district resource allocation formula in Malawi was recently reviewed to include stunting as a proxy measure of socioeconomic status. In many countries where the concept of need has been incorporated in resource allocation, composite indicators of socioeconomic status have been used. In the Malawi case, it is important to ascertain whether there are differences between using single variable or composite indicators of socioeconomic status in allocations made to districts, holding all other factors in the resource allocation formula constant.MethodsPrincipal components analysis was used to calculate asset indices for all districts from variables that capture living standards using data from the Malawi Multiple Indicator Cluster Survey 2006. These were normalized and used to weight district populations. District proportions of national population weighted by both the simple and composite indicators were then calculated for all districts and compared. District allocations were also calculated using the two approaches and compared.ResultsThe two types of indicators are highly correlated, with a spearman rank correlation coefficient of 0.97 at the 1% level of significance. For 21 out of the 26 districts included in the study, proportions of national population weighted by the simple indicator are higher by an average of 0.6 percentage points. For the remaining 5 districts, district proportions of national population weighted by the composite indicator are higher by an average of 2 percentage points. Though the average percentage point differences are low and the actual allocations using both approaches highly correlated (ρ of 0.96), differences in actual allocations exceed 10% for 8 districts and have an average of 4.2% for the remaining 17. For 21 districts allocations based on the single variable indicator are higher.ConclusionsVariations in district allocations made using either the simple or composite indicators of socioeconomic status are not statistically different to recommend one over the other. However, the single variable indicator is favourable for its ease of computation.

Assessment of need and capacity to benefit for people with a disability requiring aids, appliances and equipment

To develop an equitable system for allocating equipment, aids and appliances to adults with disabilities based on assessment of need and capacity to benefit for use by occupational therapists, who are the main professional group involved in assessing and prioritising applications. An assessment tool was developed, pilot tested and field tested at four sites in New South Wales. Assessments were undertaken in parallel with existing systems. Feedback on use of the tool was obtained from those conducting the assessments and those making decisions to fund applications for equipment based on the assessments. One hundred and six assessments were undertaken. Applications for bed, sleeping and seating equipment and equipment to assist with mobility, toileting, showering and transfers accounted for 94.2% of equipment requested. Provision of equipment was expected to have greatest impact on the physical effort and safety of carers and the safety and quality of life of applicants. Regression analysis identified assessment items that explain variation between applicants and that can avoid unnecessary data collection. The assessment tool provides a standardised method for assessing requests for equipment based on the twin concepts of need and capacity to benefit. The results support the use of both concepts as the foundation of the assessment process. Further development is required, particularly to move to the next stage of using the assessment tool as the basis for prioritising applications for equipment.

AN INQUIRY INTO THE PRINCIPLES OF NEEDS‐BASED ALLOCATION OF HEALTH CARE

The concept of need is often proposed as providing an additional or alternative criterion to cost-effectiveness in making allocation decisions in health care. If it is to be of practical value it must be sufficiently precisely characterized to be useful to decision makers. This will require both an account of how degree of need for an intervention is to be determined and a prioritization rule that clarifies how degree of need and the cost of the intervention interact in determining the relative priority of the intervention. Three common features of health care interventions must be accommodated in a comprehensive theory of need: the probabilistic nature of prognosis (with and without the intervention); the time course of effects; and the fact that the most effective treatments often combine more than one intervention. These common features are problematic for the concept of need. We outline various approaches to prioritization on the basis of need and argue that some approaches are more promising than others.

Assessing the Need for a New Medical School: A Case Study in Applied Demography

This case study illustrates how applied demographers operate in a politically charged context of competing interests—here, justifying the decision to locate a new public medical school in one medically underserved region rather than another. We show how to use demographic and other data to gauge the magnitude of future demand for physicians; formulate demographic assumptions about the future to serve decisionmakers’ needs; and frame information to help improve decision making through objective analysis. We detail the steps in projecting future physicians per capita using a method based on the economic concept of physician demand rather than the social concept of need. Our method is computationally simple, intuitive, and easily understood by policymakers. Our case study offers applied demographers a practical approach to physician workforce planning and can be used as an instructional exercise for students, assigned to replicate these projections elsewhere and distill their implications.

Conceptualizing Supports and the Support Needs of People With Intellectual Disability

This is the third in a series of perspective articles (Schalock et al., 2007; Wehmeyer et al., 2008) from the Terminology and Classification Committee of the American Association on Intellectual and Developmental Disabilities (AAIDD). The purpose of these articles is to share our thoughts on critical issues associated with terminology, definition, and classification in the field of intellectual disability and to seek input from the field as we prepare the 11th edition of AAIDD’s Diagnosis, Classification, and System of Supports Manual (the working title). In the first article (Schalock et al., 2007), we explained the reasons for shifting from the term mental retardation to intellectual disability. Although the two terms cover the same population of individuals, we concluded that intellectual disability was the better term because it

Population Health Metrics for Surgery: Effective Coverage of Surgical Services in Low‐Income and Middle‐Income Countries

Access to surgical services is emerging as a crucial issue in global public health. "Effective coverage" is a health metric used to evaluate essential health services in low- and middle-income countries. It measures the fraction of potential health gained that is actually realized for a given intervention by integrating the concepts of need, use, and quality. This study applies the concept of effective coverage to surgical services by considering injuries and obstetric complications as high-priority surgical conditions in low- and middle-income countries. Effective coverage for both is poor, but it is less well defined for traumatic conditions compared to obstetric conditions owing to a lack of data. More primary and secondary data are critical to measure effective coverage and to estimate the resources required to improve access to surgical services in low- and middle-income countries.