During the 1980’s -1990’s, Andersen’s model was again revised to form three components with a linear relationship: 1) primary determinants; 2) health behaviors; and 3) health outcomes (Figure 5). Primary determinants are noted as the direct cause of health behaviors; these determinants include characteristics of the population (i.e., demographics), the health care system (i.e., resources and organization), and the external environment (i.e., political, physical, and economic influences of utilization). In addition, the model explains that health behaviors determine health outcomes. Health behaviors include personal health practices (i.e., diet and exercise) and the use of health services. Lastly, the model indicates that health behaviors are the direct cause of health outcomes. Health outcomes include perceived health status, evaluated health status, and consumer satisfaction (Andersen, 1995).