ArticleAccess in health services research: The battle of the frameworks
Section snippets
Access as Use
There is one dominant and several lesser known theories of access. The most important and most often cited is what was originally called the “Behavioral Model of Health Services Use” developed by Ronald Andersen as part of his dissertation and subsequently published with John F. Newman as a study of “Societal and Individual Determinants of Medical Care Utilization in the United States”4 and with LuAnn Aday as a “Framework for the Study of Access to Medical Care.”5 Aday and Andersen called
Access as FIT
Roy Penchansky proposed an alternative approach to understanding access that focused on the interaction of key elements that determined use of services.18, 19 Penchansky suggested the concept of “fit” between the patient’s needs and the system’s ability to meet those needs. He suggested that this fit could be measured across 5 dimensions (Figure 2): (1) availability which is the volume of physician and other health care services; (2) accessibility, the spatial or geographic relationship between
Practical Applications of Access Theories
A practical application of the “fit” concept was proposed by Taylor to underpin the development of indices of underservice.21 This combined metric has been used in the development of proposals to modify the federal Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA) designations that are used by the federal government to allocate resources for safety-net care.22 The “fit” concept essentially suggests that there are recursive interrelationships between resources,
The dimensions of time, anticipation and experience
In general, it is possible to say that much of the analysis of access has been done using cross-sectional analysis and the models that have been used to guide that study are relatively static. They tend to relate to discrete events where a person is in need of services, seeks them out and receives some form of care, advice, or therapy, and the outcome is measured. At the population level, it is relatively fixed variables that are considered, such as overall insurance coverage, ratio of
Thomas C. Ricketts is a Professor of Health Policy and Administration at the School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Thomas C. Ricketts is a Professor of Health Policy and Administration at the School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Laurie J. Goldsmith is a Post-Doctoral Fellow at the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.