© 1972 Oxford University Press
research-article |
Forecasing Resourse Requirements for the Hospitalization of Heart Patients
1 School of Public Health, University of California Los Angeles, California, U.S.A.
Gurfield, R. M. (School of Public Health, University of California, Los Angeles, California, U.S.A.). Forecasting resource requirements for the hospitalization of heart patients. Int. J. Epid. 1972, 1 295–305.
The task of providing health services to a defined population can be formulated in terms of ‘What services do we want to have at certain specific times in the future?’ and, ‘What steps need to be taken in the near and intermediate future to provide such services?’ Ordinarily problems of region-wide distribution have only minor impact on the planning decisions of health services providers. Consequently severe distribution problems such as local shortages of services, price inflation, as well as underused and obsolescent facilities often result.
What can we do about these problems ? A first step is to look at alternative resource allocation strategies and to evaluate them by their likely costs and outcomes. To permit such evaluations I have created a model which relates future demand for health services to five independent variables—population, epidemiology, size of service population, medical practice and health services technology.
To illustrate a particular application, the study next investigates the demand for hospital services by heart patients in California until 1990. By using available data and by combining assumptions and forecasts, I have created scenarios for the late 1980's, anticipating low, medium and high resource demands. By the late 1980's, in comparison to 1968, the estimated demand may increase by a factor of two due to population growth, a change in the prevalence of disease, and even a change in the proportion of persons with access to medical care.
But under certain assumptions if resource intensive techniques such as coronary artery grafting or other heart surgery became widespread for coronary artery disease patients, the demands for surgery, catheterization and associated services would be almost fifteen times greater than they were in 1968.
The conclusion we must draw from examining possible social, medical and technical changes is that technical changes affecting resource use per heart patient have a potentially greater affect on resource demand than other variables. Surprisingly the literature largely ignores the impact of technology on future resource demand in heart disease and health services in general.
Furthermore, because technology does not advance at the same rate in all areas, the demand for some services is likely to grow more rapidly than the demand for others. Planning techniques which do not explicity take these different demand growth rates into account, but instead continue to allocate resources uniformly according to such parameters as population size, tend to perpetuate shortages and simultaneous oversupplies of services even though the total amount of resources has increased.
Received 17 July 1972