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Int J Equity Health. 2013 Mar 11;12:18. doi: 10.1186/1475-9276-12-18.

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

Author information

1
Institut national de santé publique du Québec, 190 Crémazie Est, Montréal, QC H2P1E2, Canada. jean-frederic.levesque@inspq.qc.ca

Abstract

BACKGROUND:

Access 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.

METHODS:

A 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.

RESULTS:

Here, 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.

CONCLUSIONS:

This 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.

PMID:
23496984
PMCID:
PMC3610159
DOI:
10.1186/1475-9276-12-18
[Indexed for MEDLINE]
Free PMC Article

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