Access

Access to health care is the ability of the patient to gain entry to the system for care that is available, timely, appropriate, and affordable. Public policy debate has focused on access as the 10th goal of the U.S. surgeon general in the Healthy People 2010. In this report, the surgeon general advances the goal to “improve access to comprehensive, high-quality health care services” as a public health goal for the nation. Recent public attention to access has focused on economic barriers to care and resultant health disparities among population groups, but the surgeon general[Page 3] acknowledges broader and more complex roots involving “the patient, provider, and system of care.”

Specific policy objectives to measure and evaluate access have been proposed as national access objectives. Notable among these objectives are “the reduction to 0% of the proportion of children and adults younger than 65 without health care coverage; increasing to 95% the proportion of people with a specific source of primary care; and increasing to at least 90% the proportion of individuals who have access to rapidly responding prehospital emergency medical services” (U.S. Department of Health and Human Services, “Access to Quality Health Services,” Healthy People 2010, pp. 1–13. As these disparate objectives demonstrate, the concept of access is complex and has far-reaching policy implications for the health system.

The study of access to health care has an extensive history and several critical dimensions that make the problem of access of key interest to policymakers.

These dimensions of access can be understood as variations on a set of critical “A” terms: availability, affordability, appropriateness (quality), and acceptability. Solving any one of these problems does not assure solution to the overall political problem of access, which has plagued health policy makers with a ferocity nearly equal to that of societal concern for health care expenditures.