Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal.
This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access.
The article uses a critical review of the major works of the leading theorists in the field of access studies.
Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care.
Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.
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- Access to Health Care in America. National Academy Press, Institute of Medicine, Washington, DC1993
- Revisiting the behavioral model and access to medical care.J Health Soc Behav. 1995; 36: 1-10
- Exploring the dimensions of access to health services.Res Theory Nurs Pract. 2002; 16: 77-90
- Societal and individual determinants of medical care utilization in the United States.Milbank Mem Fund Q. 1973; 51: 95-124
- A framework for the study of access to medical care.Health Serv Res. 1974; 9: 208-220
- Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team.MMWR Recomm Rep. 2003; 52: 1-12
- Demographic characteristics of persons without a regular source of medical care—selected states, 1995.MMWR Morb Mortal Wkly Rep. 1998; 47: 277-279
- Measuring access to care.Health Aff. 1998; 17: 180-186
- Pressures on safety net access.Health Serv Res. 1999; 34: 255-270
- How well do communities perform on access to care for the uninsured. Center for Studying Health System Change, 1998
- Models for organizing the delivery of personal health services and criteria for evaluating them.Milbank Mem Fund Q. 1972; 50: 103-154
- Development of Indices of Access to Medical care. Health Administration Press, Ann Arbor, MI1975
- Health Administration Press, Chicago, IL2004 Evaluating the Healthcare System, Effectiveness, Efficiency and Equity. 3rd ed.
- AHSR Health Administration Press, Chicago, IL1998 Evaluating the Healthcare System Effectiveness, Efficiency, and Equity. 2nd ed.
- Effects of community factors on access to ambulatory care for lower-income adults in large urban communities.Inquiry. 2004; 41: 39-56
- A framework for evaluating safety-net and other community-level factors on access for low-income populations.Inquiry. 2004; 41: 21-38
- Access to medical care for low-income persons.Med Care Res Rev. 2002; 59: 384-411
- The concept of access.Med Care. 1981; 19: 127-140
- The Concept of Access, a Definition. National Health Planning Information Center, Bureau of Health Planning Resources Development, Department of Health, Education and Welfare, 1977
- Relating satisfaction with access to utilization of services.Med Care. 1984; 22: 553
- The measurement of underservice and provider shortage in the United States.Rural Health Research Program. Cecil G. Sheps Center for Health Services Research, University of North Carolina, 1994
- Toward a New Designation of Underservice. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 2002
- The concept and measurement of accessibility.in: White K.L. Health Services Research an Anthology. Pan American Health Organization, Washington, DC1992: 842-855 (Vol. Scientific Publication No. 534)
- Beyond coverage and supply.Health Serv Res. 1998; 33: 625-652
- Measuring access to care through population-based surveys.Health Serv Res. 1998; 33: 685-708
- Incorporating Health Status Indicators into the Measurement of Medical Underservice. Lewin and Associates, 1986
- Ambulatory Care Sensitive Conditions Definitions and Rationale. United Hospital Fund of New York and the Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 1991
- Preventable hospitalizations and access to health care.JAMA. 1995; 264: 305-311
- The effects of having a regular doctor on access to primary care.Med Care. 1996; 34: 138-151
- The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care.Ann Intern Med. 2003; 13: 273-287
- Do HMOs make a difference?.Access to health care. Inquiry. 1999; 36: 390-399
- Physician supply and access to care in urban communities.Health Aff. 1997; 16: 71-86
- The use and availability of medical care in health manpower shortage areas.Inquiry. 1983; 20: 369-380
- Changes in usual source of care and perceptions of health care access, quality and use.Med Care. 2004; 42: 975-984
- Choice of health plan.Health Care Financ Rev. 1998; 20: 29-43
- Access to care.Health Aff (Millwood). 1998; 17: 169-180
- The functions and limitations of trust in the provision of medical care.J Health Polit Policy Law. 1998; 23: 661-687
- R-E-S-P-E-C-T.J Fam Pract. 2004; 53: 721
- Skepticism toward medical care and health care utilization.Med Care. 1998; 36: 180-189
- Does skepticism towards medical care predict mortality?.Med Care. 1999; 37: 409-414
- The doctor-patient relationship in US primary care.J R Soc Med. 2003; 96: 180-184
- Switching doctors.J Fam Pract. 2001; 50: 130-136
- The role of physician recommendation in women’s mammography use.Med Care. 2000; 38: 392-403
- Center for Health Administration Studies Research Series, 1968: 25 A Behavioral Model of Families’ Use of Health Services.
- Continuity and coordination in primary care.Med Care. 1976; 14: 625-636
- Measuring provider continuity in ambulatory care.Med Care. 1979; 17: 551-565
- Lost in transition.Ann Intern Med. 2004; 141: 533-536
- Quality of care in relation to a critical pathway from the staff’s perspective.J Nurs Manag. 2004; 12: 309-316
- Organizing care for patients with chronic illness.Milbank Q. 1996; 74: 511-544
- Health literacy, social support, and health.Soc Sci Med. 2004; 58: 1309-1321
- Reimbursement denial and reversal by health plans at a university hospital.Am J Med. 2004; 117: 629-635
- Does health systems thinking guide health services actions?.Health Serv Res. 2000; 34: 1409-1412
Thomas C. Ricketts is a Professor of Health Policy and Administration at the School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Laurie J. Goldsmith is a Post-Doctoral Fellow at the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.