Needs-based planning: the case of Manitoba.

OBJECTIVE To illustrate the use of needs-based planning in the identification of physician surpluses and deficits and of resource misallocations within a provincial medical system at a time when provincial governments and medical associations across the country are faced with funding constraints for physician services. DESIGN For each of 4 regions in Manitoba, the authors analysed residents' rates of physician visits (whether within the resident's own or another region). Residents' need for physician contact was estimated by means of a statistical analysis of the data on contacts in relation to age, sex and health-related indicators, and the rates of visits needed and actually made were compared. PARTICIPANTS All Manitoba residents. OUTCOME MEASURES Numbers of generalist physicians (general practitioners, family physicians, general internists and general pediatricians) needed to serve each region, and the extent of physician surplus and deficit in each region. RESULTS 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 provide a significant part of the ambulatory care that is provided by general practitioners in other parts of the province. The provincial government currently spends more per resident to provide physician services in areas of physician surplus than in areas of physician deficit, although 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 so.