Health status as a measure of need for medical care: a critique.

At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determining whether a given level of health-service utilization is appropriate for the optimization of health status in a population is considered. As part of this task, we review the concept of health, its measurement, and data on the relationship between changes in utilization and changes in health status. Although the Use-Disability ratio may be a useful instrument to measure access equity, it appears less suited for the purpose stated above. Elements of both the Symptoms-Response Ratio and the Episode of Illness Analysis appear better suited for this purpose. Recommendations are provided on 1) the scope of services that should be included in a comprehensive construct designed to assess access related to health status, and 2) the required research to develop such a construct.