In this elaborated model the predisposing, enabling and need factors of Andersen are explained by two groups of underlying factors: individual factors and health service factors.
Finally, the need factors of having ever been diagnosed with an STI, having ever accessed drug treatment and having ever wanted to receive help to stop drug use were found to be associated with HIV testing.
17 Although the 2011 NDHS collected information on planning activities related to preparation of clothes, delivery kit and food, these activities did not necessarily imply the need for facility delivery; consequently, they were not considered as need factors of institutional delivery service use.
Purging the effects of need factors on utilization of bias resulting from non-need determinants is critical to estimating need from utilization data[ 5, 18].
In this study we investigated the impact of demographic, socio-economic and need factors on the utilization of health services.
The main finding of our study is that the need factor of the Andersen model, operationalized through a measure of MM (CIRS-G) and complemented by a measure of mental health status (SF-12 MSC), was the dominant and most consistent predictor of health care costs.
For needs factors, the presence of a comorbid anxiety disorder (OR = 0.51; 95 % CI [0.28 0.94]) reduced the odds of reception of an adequate psychological treatment.
We categorised approaches to constructing funding formulae under three main themes: identifying factors which predict differential need amongst populations; adjusting for cost factors outside of needs factors; and engaging in normative correction of allocations for 'unmet' need.
After controlling for household-level predisposing, enabling and need factors, measures of local area ethnic composition were significantly associated with likelihood of households' registration for the Fair PharmaCare program (p < 0.05).
The fact that two evaluated need factors, severity of depressive symptoms and comorbid anxiety disorder, were retained in the multilevel model is encouraging: people more in need are more likely to receive adequate care.
