Davidson Pamela L, Andersen Ronald M, Wyn Roberta, Brown E Richard
Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA.
Inquiry. 2004 Spring;41(1):21-38. doi: 10.5034/inquiryjrnl_41.1.21.
The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.
本文提出的框架扩展了健康服务利用研究的安德森行为模型，以检验获取医疗服务的背景决定因素的影响。本文提出了一个概念框架，用于选择和构建背景（或社区层面）变量，这些变量代表影响低收入人群医疗服务使用情况的社会、经济、结构和公共政策环境。背景变量反映了过度依赖医疗安全网的人群特征、对低收入和安全网人群的公共政策支持，以及该市场内医疗市场和安全网服务的结构。直到最近，该领域的文献大多是定性和描述性的，很少有多元研究全面调查获取医疗服务的背景决定因素。该框架提出的全面系统方法将使研究人员能够通过考虑跨地点和人群的一组一致背景因素的影响，来增强研究结果的外部有效性。本期《探究》杂志随后的一篇文章应用该框架，研究了有保险和无保险的低收入成年人获得门诊护理的情况。
