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.
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