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

被引:217
作者
McIntyre, Di [1 ]
Thiede, Michael
Birch, Stephen [2 ,3 ]
机构
[1] Univ Cape Town, Sch Publ Hlth & Family Med, Fac Hlth Sci, Dept Publ Hlth & Family Med,Hlth Econ Unit, ZA-7925 Observatory, South Africa
[2] McMaster Univ, Hamilton, ON L8S 4L8, Canada
[3] Univ Manchester, Manchester M13 9PL, Lancs, England
关键词
PRIMARY-HEALTH-CARE; UNITED-STATES; MEDICAL-CARE; EQUITY; SERVICES; POVERTY;
D O I
10.1017/S1744133109004836
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:179 / 193
页数:15
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