Healthcare Quarterly

Healthcare Quarterly 3(3) March 2000 : 52-52.doi:10.12927/hcq..16714
Book Review

Demanding Patients? Analyzing the Use of Primary Care

Peggy Leatt


Demanding Patients? Analyzing the Use of Primary Care
Anne Rogers, Karen Hassell, and Gerry Nicolaas
Open University Press. Buckingham. 1999.

Anne Rogers and her colleagues from the National Primary Care Research and Development Center at the University of Manchester, England, present a somewhat unusual perspective in Demanding Patients by focusing on patients and their families and their experiences with the National Health Services in Britain. As a result, the outstanding contribution of the book is the authors' analysis of the meaning of "demand" for health services as opposed to the concept of healthcare "need." The implications of this analysis have relevance for healthcare providers across the spectrum.

Early in the book, Prof. Rogers and her colleagues raise the issue of inappropriate demand for health services. This has always been a very thorny issue for healthcare providers since the "demand" for services will almost inevitably exceed the "supply." In most countries this is also intricately entwined with cultural norms.

In the Canadian context, inappropriate use of health services is an anathema to many providers and policy makers since it implies that somewhere there are individuals who are taking advantage or misusing health services. This goes against the grain since the Canada Health Act is intended to insure comprehensive health services are equally accessible to all Canadians.

Approaching the issue of demand from the patients' side, the reader is better able to understand the concept of health services rationing - whether explicit or implicit. Many providers are not comfortable with this concept since it implies the denial of other services to a different population.

In this book, the authors draw on examples from primary healthcare and the patients' perceptions of these services. The authors also use illustrations from pharmacy to expand on the realities of unmet demand.

The authors explore traditional approaches to the study of health services utilization and their shortcomings. A number of different perspectives are discussed, including the patterns of social processes that influence a patient's decision to seek care and from whom. This discussion covers an active debate about the provision of informal care and self care by individuals and their families and friends.

In the concluding chapters, the authors describe the attempts to control demand through policies and management action. It is clear that there is still much to learn about how to meet increasing expectations for a broader range of diverse health service under times of resource constraints.

Demanding Patients will be of interest to providers and consumers alike. It may be particularly useful for those involved in setting policies for which services must be provided under the auspices of government, and those involved with the sticky issue of dealing with waiting lists and other traditional attempts to ration the supply of health services


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