NEEDS-BASED PLANNING - THE CASE OF MANITOBA

Objective: To illustrate the use of needs-based planning in the identi fication of physician surpluses and deficits and of resource misalloca tions within a provincial medical system at a time when provincial gov ernments and medical associations across the country are faced with fu nding constraints for physician services. Design: For each of 4 region s in Manitoba, the authors analysed residents' rates of physician visi ts (whether within the resident's own or another region). Residents' n eed for physician contact was estimated by means of a statistical anal ysis of the data on contacts in relation to age, sex and health-relate d indicators, and the rates of visits needed and actually made were co mpared. Participants: All Manitoba residents. Outcome measures: Number s of generalist physicians (general practitioners, family physicians, general internists and general pediatricians) needed to serve each reg ion, and the extent of physician surplus and deficit in each region. R esults: There appeared to be a surplus of physicians in most of urban Manitoba but deficits in northern Manitoba and some parts of the rural south. General internists and general pediatricians in Winnipeg provi de a significant part of the ambulatory care that is provided by gener al practitioners in other parts of the province. The provincial govern ment currently spends more per resident to provide physician services in areas of physician surplus than in areas of physician deficit, alth ough the patterns are inconsistent. Conclusions: Needs-based planning is possible. If provinces are intent on controlling physician numbers and expenditures, it makes sense to manage the implications of doing s o.