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Access as a policy-relevant concept in low- and middle-income countries

Published online by Cambridge University Press:  01 April 2009

DI MCINTYRE ,
MICHAEL THIEDE  and
STEPHEN BIRCH
DI MCINTYRE*
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa
MICHAEL THIEDE
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa
STEPHEN BIRCH
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, McMaster University and University of Manchester, UK
*
*Corresponding author: Di McIntyre, Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Health Sciences Faculty, Anzio Road, Observatory 7925, South Africa. Email: [email protected]
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Abstract:

Although access to health care is frequently identified as a goal for health care policy, the precise meaning of access to health care often remains unclear. We present a conceptual framework that defines access to health care as the empowerment of an individual to use health care and as a multidimensional concept based on the interaction (or degree of fit) between health care systems and individuals, households, and communities. Three dimensions of access are identified: availability, affordability, and acceptability, through which access can be evaluated directly instead of focusing on utilisation of care as a proxy for access. We present the case for the comprehensive evaluation of health care systems as well as the dimensions of access, and the factors underlying each dimension. Such systemic analyses can inform policy-makers about the ‘fit’ between needs for health care and receipt of care, and provide the basis for developing policies that promote improvements in the empowerment to use care.

Type
Special Section on Access to Health Care
Information
Health Economics, Policy and Law , Volume 4 , Issue 2 , April 2009 , pp. 179 - 193
Copyright
Copyright © Cambridge University Press 2009

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References

Aday, L.A. (1975), ‘Economic and noneconomic barriers to the use of needed medical services’, Medical Care, 13(6): 447–456.CrossRefGoogle Scholar
Andersen, R. (1995), ‘Revisiting the behavioural model and access to medical care: does it matter?’, Journal of Health and Social Behaviour, 36(1): 1–10.CrossRefGoogle ScholarPubMed
Benzeval, M. and Judge, K. (1996), ‘Access to health care in England: continuing inequalities in the distribution of GPs’, Journal of Public Health Medicine, 18: 23–40.Google ScholarPubMed
Birch, S. (1997), ‘As a matter of fact: evidence-based decision-making unplugged’, Health Economics, 6: 547–5593.0.CO;2-P>CrossRefGoogle ScholarPubMed
Birch, S. and Abelson, J. (1993), ‘Is reasonable access what we want? Implications of, and challenges to, current Canadian policy on equity in health care’, International Journal of Health Services, 23: 629–653.CrossRefGoogle ScholarPubMed
Birch, S. and Anderson, R. (2005), ‘Financing and delivering oral health care: what can we learn from other countries?’, Journal of the Canadian Dental Association, 71: 243–247.Google ScholarPubMed
Brabyn, L. and Skelly, C. (2002), ‘Modeling population access to New Zealand public hospitals’, International Journal of Health Geographics, 1: 3.CrossRefGoogle ScholarPubMed
Culyer, A. and Wagstaff, A. (1993), ‘Equity and equality in health and health care’, Journal of Health Economics, 12: 431–457.CrossRefGoogle ScholarPubMed
Donabedian, A. (1973), Aspects of Medical Care Administration, Cambridge, MA: Harvard University PressGoogle Scholar
Falkingham, J. (2004), ‘Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan’, Social Science and Medicine, 58: 247–258.CrossRefGoogle ScholarPubMed
Finkelstein, M. (2001), ‘Do factors other than need determine utilization of physicians’ services in Ontario?’, Canadian Medical association Journal, 165: 565–570.Google ScholarPubMed
Gilson, L. (2007), ‘Acceptability, trust and equity’, in McIntyre, D. and Mooney, G. (eds.), The Economics of Health Equity, Cambridge: Cambridge University Press.Google Scholar
Goddard, M. and Smith, P. (2001), ‘Equity of access to health care services: theory and evidence from the UK’, Social Science and Medicine, 53: 1149–1162.CrossRefGoogle ScholarPubMed
Grytten, J., Rongen, G., and Sorensen, R. (1995), ‘Can a public health system achieve equity? the Norwegian experience’, Medical Care, 33: 938–951.CrossRefGoogle ScholarPubMed
Guagliardo, M. (2004), ‘Spatial accessibility of primary care: concepts, methods and challenges’, International Journal of Health Geographics, 3: 3.CrossRefGoogle Scholar
Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., and Hudson, M. (2002), ‘What does “access to health care” mean?’, Journal of Health Services Research and Policy, 7(3): 186–188.CrossRefGoogle Scholar
Gulliford, M. and Morgan, M. (2003), Access to Health Care, London: Routledge.Google ScholarPubMed
Jütting, J. (2001), ‘The impact of health insurance on the access to health care and financial protection in rural areas of developing countries: the example of Senegal’, Centre for Development Research, Bonn.Google Scholar
Katz, S. and Hofer, T. (1994), ‘Socioeconomic disparities in preventive care persist despite universal coverage: breast and cervical screening in Ontario and the United States’, Journal of the American Medical Association, 272: 530–534.CrossRefGoogle ScholarPubMed
Le Grand, J. (1991), Equity and Choice: An Essay in Economics and Applied Philosophy, London: Harper CollinsCrossRefGoogle Scholar
Lieu, T., Newacheck, P., and McManus, M. (1993), ‘Race, ethnicity and access to ambulatory care among US adolescents’, American Journal of Public Health, 83: 960–965.CrossRefGoogle ScholarPubMed
McIntyre, D., Thiede, M., Dahlgren, G., and Whitehead, M. (2005), ‘What are the economic consequences for household of illness and of paying for health care in low- and middle-income country contexts?’, Social Science and Medicine, 62: 858–865.CrossRefGoogle ScholarPubMed
Mooney, G., Hall, J., Donaldson, C., and Gerard, K. (1991), ‘Utilisation as a measure of equity: weighing heat?’, Journal of Health Economics, 10: 465–470.CrossRefGoogle ScholarPubMed
Oliver, A. and Mossialos, E. (2005), ‘Equity of access to health care: outlining the foundations for action’, Journal of Epidemiology and Community Health, 58: 655–658.CrossRefGoogle Scholar
Penchansky, R. (1977), ‘The concept of access: a definition’, National Health Planning Information Centre, Department of Health, Education and Welfare, Hyattsville.Google Scholar
Perera, M., Gunatilleke, G., and Bird, P. (2007), ‘Falling into the medical poverty trap in Sri Lanka: what can be done?’, International Journal of Health Services, 37(2): 379–398.CrossRefGoogle Scholar
Perry, B. and Gesler, W. (2000), ‘Physical access to primary health care in Andean Bolivia’, Social Science and Medicine, 50: 1177–1188.CrossRefGoogle ScholarPubMed
Puffer, F. (1986), ‘Access to primary health care: a comparison of the US and UK’, Journal of Social Policy, 15: 293–313.CrossRefGoogle Scholar
Ricketts, T. and Goldsmith, L. (2005), ‘Access in health services research: the battle of the frameworks’, Nursing Outlook, 53: 274–280.CrossRefGoogle ScholarPubMed
Rosero-Bixby, L. (2004), ‘Spatial access to health care in Costa Rica and its equity: a GIS-based study’, Social Science and Medicine, 58: 1271–1284.CrossRefGoogle ScholarPubMed
Russell, S. (2001), ‘Can households afford to be ill? The role of the health system, material resources and social networks in Sri Lanka’, Ph.D. thesis, Health Policy Unit Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.Google Scholar
Russell, S. (2004), ‘The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis and Human Immunodeficiency Virus/Aquired Immunodeficiency Syndrome’, American Journal of Tropical Medicine and Hygiene, 7(Suppl 2): 147–155.CrossRefGoogle Scholar
Tanser, F., Gijsbertsen, B., and Herbst, K. (2006), ‘Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system’, Social Science and Medicine, 63: 691–705.CrossRefGoogle ScholarPubMed
Taylor, D., Aday, L., and Andersen, R. (1975), ‘A social indicator of access to medical care’, Journal of Health and Social Behavior, 16(1): 39–49.CrossRefGoogle ScholarPubMed
Tianviwat, S., Chongsuvivatwong, V., and Birch, S. (2008), ‘Different dental care settings: does income matter?’, Health Economics, 17: 109–118.CrossRefGoogle ScholarPubMed
Vilhjalmsson, R. (2005), ‘Failure to seek needed medical care: results from a national health survey of Icelanders’, Social Science and Medicine, 61, 1320–1330.CrossRefGoogle ScholarPubMed
Wang, F. and Luo, W. (2005), ‘Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas’, Health and Place, 11: 131–146.CrossRefGoogle ScholarPubMed
Waters, H. (2000), ‘Measuring equity in access to health care’, Social Science and Medicine, 51: 599–612.CrossRefGoogle ScholarPubMed
Whitehead, M., Dahlgren, G., and Evans, T. (2001), ‘Equity and health sector reforms: can low-income countries escape the medical poverty trap?’, Lancet, 358: 833–836.CrossRefGoogle ScholarPubMed