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[Needs-based equity: an international comparison]
Fabian Kleinke1, Aletta Boerkoel2, Stefan Mathis-Edenhofer3
1Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland. fabian.kleinke@uni-greifswald.de.
None:
The distribution of healthcare resources represents a major challenge for modern health systems. This article compares how Germany, the Netherlands, Austria, Sweden, and England plan their healthcare provision to achieve needs-based equity. German outpatient healthcare planning relies mainly on fixed physician-to-population ratios and covers only physicians and psychotherapists. In contrast, other countries use more comprehensive approaches: The Netherlands regulates training capacities for 79 different health professions using simulation models to predict future workforce needs. Austria integrates planning across hospital beds, healthcare personnel, and geographic accessibility based on the "Best Point of Service" principle. Sweden uses population-based models that incorporate the Care Need Index, which considers social and health factors alongside legally guaranteed treatment timelines. England applies weighted funding formulas that explicitly consider preventable deaths and socioeconomic disadvantage when allocating resources. This comparison shows significant opportunities for Germany to improve its planning system, especially by including multiple healthcare professions, coordinating across care sectors, addressing social inequalities in health, and integrating non-physician professions such as midwives into systematic planning. The findings indicate that moving from simple population ratios toward outcome-focused planning methods that account for socioeconomic factors is essential for achieving true needs-based equity in healthcare.
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