Sock-Econ Plan. Sci Val 17, No. 4. pp. 225-234. 1983 Prmted in Great Britam W3&0121/83 $3 Ml + 00 Pergamon Press Ltd zyxwvuts INDICATORS FOR PLANNING OF HEALTH SERVICES: ASSESSING IMPACTS OF SOCIAL AND HEALTH CARE FACTORS ON POPULATION HEALTH THOMAS T. H. WAN Department of Health Administration, Medical College of Virginia. Virginia Commonwealth University, MCV Station Box 203, Richmond. VA 23298, U.S.A. and JOEL H. BROIDA National Center for Health Services Research, Department of Health and Human Services, Rockville MD 20857 U.S.A. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCB (Received 29 July 1982) Abstract-Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians’ responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved. INTRODUCTION In order to reduce costs, provide rational delivery sys- tems, and assure equal access to medical care, it is necessary to systematize the planning of health services. Planning for health requires precise information on health service needs of the population and the factors that affect variations in use of health services in each community. This research is an exploratory study of the relation- ships among various components of a health care system that has evolved through a major change in health in- surance coverage for the population. The purposes of this study are two-fold: (1) to formulate a heuristic model of a health care system consisting of six major com- ponents-socio-economic, demographic, environmental, health care resources, health care use, and health care outcomes; and (2) to examine the relationship of social and health care factors to community health. Previous research has shown that many social and health care factors exert differential impacts on popu- lation health (Wennberg and Gittelsohn[ 11; Anderson[2,3]; Ohmura[4]; Kisch et al.[5]; Gentry[6]; Auster et al.[7]). In order to facilitate our analysis of community health, socio-medical indicators were classified into six broad categories (see Fig. 1). The first category is a socio-economic profile of the community including education, poverty, and ethnicity. The second is demographic measures composed of aging, sex ratio and infant and total mortality rates. The third category, environmental indicators, is made up of rurality, popu- lation density, and metropolitanism characteristics of the community. The fourth category consists of indicators of health care availability and access to care. The fifth category is made up of measures of the extent of in- equalities in health services use. Finally, health outcome indicators complete the classification model. Based upon information derived from varying sources of data available on the small geographic areas (medical market areas), we developed social and health profiles of the 64 designated sub-areas for the Province of Quebec, Canada. It was postualted that community health varied directly with the degree of equalities in use of health services. In addition, it was expected that all the com- ponents of the health care system might play a con- tributory role in influencing health status within the sub-areas. If the hypothesized influence of health care use is proved to be the most important determinant of popu- lation health, social policies can be implemented to reduce the inequalities of access and subsequently the disparities in health care conditions can then be lessened. Furthermore, health program planning can be more effectively executed if differences in health care needs among communities can be assessed and detected. It is our intent to demonstrate that small areas analysis of pertinent social and health indicators can accomplish these goals. RATIONALE FOR A SYSTEMS MODEL The key conceptual or theoretical dimensions of a health care system can be specified at several levels with the aid of macro-theory as the foundation (Silver[b]; Knox[9]). The first step is to delineate a series of com- munity characteristics in terms of socio-economic, demographic and environmental pre-conditions that greatly influence health resources and manpower needs. Of particular importance, at least in other studies, is the level of poverty in a given community, which has been shown to be inversely related to both the distribution of health manpower and resources. Also important is the recognioion that the higher the educational attainment that one community has achieved, the better is its level of population health. Under specific environmental con- ditions, another set of variables presumably emerged as 225