title: The role of proximity to death in need-based approaches to health care.
abstract: OBJECTIVE
  This study examines the role of proximity to death (PTD) in need-based approaches to health care by: (1) investigating whether PTD is a statistically significant, independent predictor of health-care use; and (2) estimating PTD's marginal impact on need-based allocation of health-care resources.
  
  
  METHODS
  The primary data source is the Canadian National Population Health Survey (NPHS), a longitudinal survey that uses vital statistics to confirm deaths of the respondents. We use two-part models separately for general practitioner, specialist, and short stay inpatient hospital services. We calculate per-capita allocation, with and without PTD, from the Canadian federal government to its ten provinces and by income groups.
  
  
  RESULTS
  PTD is a robust and important predictor of health-care resource use for each service even after adjustment for other need and non-need factors. PTD's marginal impact on allocation is relatively small in the contexts we examined, but failure to include PTD could introduce inequity in allocation by disadvantaging populations with greater need.
  
  
  CONCLUSIONS
  PTD is an important need indicator when modeling health-care resource requirements. It deserves greater attention in need-based approaches to health-care planning and resource allocation.
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7 Canada. yukiko.asada@dal.ca
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Asada
authors.forename: George
authors.initials: G
authors.lastname: Kephart
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hurley
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Andrea
authors.initials: A
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Bornstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D015276:Health Care Rationing; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009313:National Health Programs / Q000458:organization & administration; D040841:Resource Allocation; D013727:Terminal Care / Q000458:organization & administration*; D014798:Vital Statistics; D055815:Young Adult