Today, access to health care services is a key measure of the overall health and prosperity of a nation or a population, but access and availability were not always linked to health status. In fact, many medical historians assert that until the beginning of the twentieth century, a visit with a physician was as likely to be harmful as it was to be helpful. It is only relatively recently—since the early twentieth century—that medical care has been considered to have a positive influence on health and longevity.
There are three aspects of accessibility: consumer access, comprehensive availability of services, and supply of services adequate to meet community demand. Quality health care services must be accessible to health care consumers when and where they are needed. The health care provider must have access to a full range of facilities, equipment, drugs, and services provided by other practitioners. The institutional component of health care delivery—the hospitals, clinics, and payers—must have access to information to enable them to plan an adequate supply of appropriate services for their communities.
Consumer Access to Care
Access to health care services is influenced by a variety of factors. Characteristics of health care consumers strongly affect when, where, and how they access services. Differences in age, educational level achieved, economic status, race, ethnicity, cultural heritage, and geographic location determine when consumers seek health care services, where they go to receive them, their expectations of care and treatment, and the extent to which they wish to participate in decisions about their own medical care.
People have different reasons for seeking access to health care services. Their personal beliefs about health and illness, motivations to obtain care, expectations of the care they will receive, and knowledge about how and where to receive care vary. For an individual to have access to quality care, there must be appropriately defined points of entry into the health care system. For many consumers a primary care physician is the portal to the health care system. In addition to evaluating the patient's presenting problem (health care need), the primary care physician also directs the consumer to other providers of care such as physician specialists or mental health professionals.
Some consumers access the health care system by seeking care from a clinic or hospital outpatient department where teams of health professionals are available at one location. Others gain entry via a public health nurse, school nurse, social worker, pharmacist, or member of the clergy who can refer them to an appropriate source, site, or health care practitioner.
Comprehensive Availability of Health Care Services
Historically, the physician was the exclusive provider of all medical services. Until the twentieth century, the family doctor served as physician, surgeon, pharmacist, therapist, advisor, and dentist. He carried all of the tools of his trade in a small bag and could easily offer state-of the-art medical care in his patient's home, since hospitals had little more to offer in the way of equipment or facilities. Today it is neither practical nor desirable to ask one practitioner to serve in all of these roles. It would be impossible for one professional to perform the full range of health care services, from primary prevention of disease and diagnosis to treatment and rehabilitation. Modern physicians and other health care practitioners must have access to a comprehensive array of trained personnel, facilities, and equipment so that they can, in turn, make them accessible to their patients.
While many medical problems are effectively treated in a single office visit with a physician, even simple diagnosis and treatment relies on a variety of ancillary (supplementary) services and personnel. To make the diagnosis, the physician may order an imaging study such as an X-ray that is performed by a radiology technician and interpreted by a radiologist (physician specialist in imaging techniques). Laboratory tests may be performed by technicians and analyzed by pathologists (physicians who specialize in microscopic analysis and diagnosis). More complicated medical problems involve teams of surgeons and high-tech surgical suites equipped with robotic assistants, and rehabilitation programs where highly trained physical and occupational therapists skillfully assist patients to regain function and independence.
Some health care services are more effectively, efficiently, and economically provided to groups rather than individuals. Immunization to prevent communicable diseases and screening to detect diseases in their earliest and most treatable stages are examples of preventive services best performed as cooperative efforts of voluntary health organizations, medical and other professional societies, hospitals, and public health departments.
Access Requires Enough Health Care Services to Meet Community Needs
For all members of a community to have access to the full range of health care services, careful planning is required to ensure both the adequate supply and distribution of needed services. To evaluate community needs and effectively allocate health care resources, communities must gather demographic data and information about social and economic characteristics of the population. They also must monitor the spread of disease and the frequency of specific medical conditions over time. All these population data must be considered in relation to available resources, including health care personnel, the distribution of facilities, equipment, and human resources (the available health care workforce), and advances in medicine and technology.
For example, a predicted shortage of nurses may prompt increased spending on nursing education; reviews of nurses' salary, benefits, and working conditions; and the cultivation of non-nursing personnel to perform specific responsibilities previously assigned to nurses. Similarly, when ongoing surveillance anticipates an especially virulent influenza (flu) season, public health officials, agencies, and practitioners intensify efforts to provide timely immunization to vulnerable populations such as older adults. Government agencies such as the Centers for Disease Control and Prevention, National Institutes of Health, state and local health departments, professional societies, voluntary health agencies, and universities work together to research, analyze, and forecast health care needs. Their recommendations allow health care planners, policymakers, and legislators to allocate resources so that supply keeps pace with demand and to ensure that new services and strategies are developed to address existing and emerging health care concerns.