Abstract :
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.
