3. Expressed Need
Expressed need or demand is felt need turned into action. Under
this definition total need is defined as the need of those people who
demand a service. One does not demand a service unless one feels
a need, but on the other hand, it is common for felt need not to
be expressed by demand. Expressed need is commonly used in the
health services where waiting-lists are taken as a measure of unmet
need. Waiting-lists are generally accepted as a poor definition of
‘real need’ – especially for presymptomatic cases.
4. Comparative Need
By this definition a measure of need is obtained by studying the
characteristics of the population in receipt of a service. If there
are people with similar characteristics not in receipt of a service,
then they are in need. This definition has been used to assess needs
both of individuals and areas. Bleddyn Davies (6) has identified the community-wide factors which indicate high incidences of
pathology in one area which are not present in another. Need
established by this method is the gap between what services exist
in one area and what services exist in another, weighted to take
account of the difference in pathology. This is an attempt to
standardize provision, but provision may still not correspond with
need. The question has to be asked – supply at what level? The
statement that one area A is in need in comparison with another
area B does not necessarily imply that area B is still not in need.
Comparative need used to define individuals in need can be
illustrated by the following statements: ‘this person X is in receipt
of a service because he has the characteristics A-N. This person Z
has also the characteristics A-N but is not receiving the service.
Therefore Z is in need.’ The difficulty in this situation is to define
the significant characteristics. The method has been used by some
local health authorities to compile a risk register of babies in
need of special attention from the preventive services. Conditions
which in the past have been associated with handicap such as
forceps delivery, birth trauma, birth to older mothers, etc., are
used as indicators to babies in special need. The definition is more
commonly used in an ad-hoc way – a crude rule of precedence
to assess eligibility for selective services provided by the personal
social services.