How will health needs be measured in districts? Implications of variations in hospital use.

Under the proposals in Working for Patients, Health Authorities will need to assess health needs in the populations for which they will become responsible, in order to ensure that optimal contracts are placed for hospital care. It seems inevitable that this process will have to be based at least in part on previous utilization data. Utilization data are known to be strongly influenced by the supply of facilities, particularly beds; unless this can be taken into account there is a likelihood that historical patterns will simply be perpetuated whether justified or not. We have used multiple regression analysis with nationally available data to investigate the effects of supply as well as of need and demand indicators on variations in hospital utilization rates. We describe how the approach may be taken by Health Authorities as the basis for a staged assessment of local levels of utilization, so that they may target further and more detailed investigation more efficiently.