Utilization-based health workforce planning projects the workforce needed to keep delivering the services a population uses today, adjusted for how that population will grow and age. Needs-based planning projects the workforce needed to deliver the services a population should receive, given its health status and evidence on effective care, whether or not it receives them today. The first asks how many providers it takes to keep the current system running. The second asks how many it takes to run the system the population needs. They produce different numbers, and the difference is the access gap.
Neither is wrong. Each answers a different question, and a mature planning function uses both: the utilization model as the operational baseline everyone can agree on, and the needs-based model where the policy question is about access, equity, or a change in the model of care. The mistake is using one without knowing which question it answers.
Utilization-based planning tells you what it costs to keep today's system running. Needs-based planning tells you what it costs to close the gap between the care people get and the care they need.
Side by side
| Utilization-based | Needs-based | |
|---|---|---|
| Demand driver | Current service use per capita, by age and sex, projected with demographics | Population health need, evidence-based level of service, and provider productivity |
| Core inputs | Utilization data (visits, admissions, procedures), population projections | Epidemiology, care standards or guidelines, planned models of care, productivity assumptions |
| Strength | Fast, transparent, defensible with routinely collected data | Exposes unmet need; supports equity and model-of-care decisions |
| Weakness | Locks in current access problems and current inefficiencies | Requires clinical judgement; assumptions are contestable; heavier to build |
| Best used for | Budget cycles, hiring targets, capital planning baselines | Access strategy, underserved populations, new service design, policy submissions |
How each is built
Utilization-based, in four moves
- Measure current service use per 1,000 population by age and sex band, by service and setting.
- Apply population projections by the same bands to get future service volume.
- Convert volume to provider requirement using current productivity (visits per FTE, cases per surgeon).
- Compare with projected supply from the stock-flow model.
Needs-based, in five moves
- Estimate the prevalence of conditions or the population risk profile, by area.
- Define the level of service each condition warrants, from guidelines or expert consensus.
- Translate service into provider time under the intended model of care (who does what).
- Apply productivity assumptions to get FTE requirement, by provider type and place.
- Compare with projected supply, and with the utilization-based estimate, to size the access gap.
Choosing, in practice
Start with utilization. It can be built in weeks from data every health system already holds, and it gives finance, HR, and operations a shared baseline. Then apply needs-based analysis to the two or three services where the policy question is access rather than continuity: primary care in underserved regions, mental health, long-term care. Those are the places where the utilization model is most misleading, because low use reflects low access, not low need.
Whichever approach is used, the output is only as useful as its supply side. A needs-based demand estimate compared with last year's headcount is a headline; compared with a projected supply that accounts for retirement and attrition, it is a plan. The two halves are described in How Health Workforce Forecasting Models Work.
Sources
- Health Workforce Canada. State of Health Workforce Modelling and Forecasting in Canada. 2024. healthworkforce.ca
- Methods for health workforce projection model: systematic review. Human Resources for Health, 2024. biomedcentral.com
- McMaster Health Forum. Exploring Models for Health Workforce Planning. 2019. mcmasterforum.org