Patient-centred access to health care: conceptualising access at the interface of health systems and populations

Abstract

BackgroundAccess is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.MethodsA synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.ResultsHere, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.ConclusionsThis paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…To generate access, these 5 dimensions have to interact with people's abilities, including the ability to perceive, which encompasses health literacy, beliefs, and expectations; ability to seek, which relates to the personal, social, and cultural values of patients; ability to reach, which pertains to the living environment, geographic location, and transportation; ability to pay, which is concerned primarily with income, economic, and insurance status; and ability to engage, which relates to empowerment, adherence, and caregiver support. 76,77 Therefore, to understand the factors that affect access to care in CVD and stroke, one must analyze each of these dimensions.…”

“…It involves transparency, outreach, information, and screening. 76 Among US stroke survivors, blacks and Hispanics may have reduced access to stroke preventive care because they have lower median household incomes, have less access to high-quality health care, and are more frequently uninsured. 78 Indeed, in the National Health Interview Survey for the years 2000 through 2006, of 4864 stroke survivors >65 years of age, Mexican Americans and non-Hispanic blacks reported a lower proportion of specialist visits compared with non-Hispanic whites.…”

“…76 A study that analyzed US Census Bureau data and the Atlas and Database of the Air Medical Services found that about half of the US population has timely access to a primary stroke center. 80 Similarly, a study analyzing the cardiology workforce found an uneven geographic distribution of cardiologists, with many rural regions having poor local access to cardiologists.…”

Patient Safety And Accessibility To Health Services

“…Trudno jest nie zgodzić się ze stwierdzeniem, że dostęp do usług medycznych powinien być zależny jedynie od stanu zdrowia pacjentów, a nie od ich statusu społeczno-ekonomicznego (Meyer, Luon, Mamerow, Ward, 2013). Jest on jednak wynikiem prowadzonej polityki zdrowotnej przez poszczególne państwa (Levesque, Harris, Russell, 2013). Prześledźmy zatem w kolejnej części artykułu dostępność do usług medycznych na przykładzie Polski.…”

Development of a measure of health care affordability applicable in a publicly funded universal health care system

“…[8][9][10][11][12] Health services are affordable if people are able to mobilize the time and money required to obtain needed health services. 13 Direct costs are those incurred from fees charged at the point of care, and in the Canadian system, these are typically payments for community-dispensed medications and non-physician health services offered outside the hospital (e.g., physiotherapy, nutrition, psychology, and social work). Indirect costs are non-health-care costs related to obtaining services, such as transport, childcare or revenue loss due to having to obtain services during working hours.…”