ABSTRACT
This chapter considers the demand or need for hospital services: that both terms are required reflects the fact that the transition to a market framework is not complete. It also considers a small number of areas which impinge critically on the way that hospitals are organised and their role in the health care sector as a whole: changes in the composition of need; routes to hospital; consumer preferences; the scope for substitution; and markets which should be conceded. For most of the post-war period, users of the National Health Service (NHS) have been patients rather than consumers, fortunate recipients of whatever providers provided. Murphy (1994) has presented an analysis of an alternative pattern of care for the elderly which took as its starting premiss the aim of reducing the use of hospital facilities. The analysis is essentially structured in three parts: preventing admissions, reducing time spent in hospital if admitted, and developing alternative forms of care delivery.
