Conclusions
Access is a concept often referred to and which has been
the subject of many discussions. The objectives of this
paper are to introduce a conceptualisation of access to
health care describing broad dimensions and determinants
that integrate demand and supply-side-factors and
enables operationalisation of access to health care all
along the process of obtaining care and benefiting from
the services.
We have defined 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
the need for services fulfilled. We have suggested five
dimensions of accessibility (Approachability; Acceptability;
Availability and accommodation; Affordability; Appropriateness)
and five corresponding abilities of populations
(Ability to perceive; Ability to seek; Ability to reach;
Ability to pay; Ability to engage).
The proposed conceptualisation of access raises some
challenges. One important challenge is the fact that
measuring access is therefore not an easy task. There are
of course various indicators available to measure whether
or not people receive services in terms of perceived needs,
if they know about available services, how they utilise
services and the distance that they have to travel, on top
of many measures describing the actual characteristics of
services. However, a true assessment of access requires
the combination of all these measures to truly judge
whether the characteristics of services, providers and
systems are aligned with people, households and communities
capabilities.
Methodological research should enable our field to
develop the measurement instruments that will better
capture the complexity of access. Adding to the complexity
is the fact that various sources of information
can inform the varied dimensions of access, but it can
be difficult to merge together to draw a complete picture
of access. Mixed method analyses of consumer surveys,
quality of care data, epidemiological surveys of utilisation,
as well as organisational surveys may be necessary.
In addition, there is a need for more research examining
the variability of access from both supply and
demand-sides and looking at the influence of local
health systems and patients’ characteristics. Empirical
studies using the framework could also test the relevance
of each dimension in different contexts and for different
types of health problems and thus assess how the five