Sanchez Raquel Maia, Ciconelli Rozana Mesquita
Universidade Federal de São Paulo, Escola Paulista de Medicina, Brasil.
Rev Panam Salud Publica. 2012 Mar;31(3):260-8. doi: 10.1590/s1020-49892012000300012.
This article describes four dimensions of health access-availability, acceptability, ability to pay and information-correlating these dimensions to indicators and discussing the complexity of the concept of access. For a study of these four dimensions, searches were conducted using the PubMed/MEDLINE, LILACS, SciELO, and World Health Organization Library & Information Networks for Knowledge (WHOLIS) databases. Large-circulation media vehicles, such as The Economist, The Washington Post, and the BBC network were also searched. The concept of health access has become more complex with time. The first analyses, carried out in the 1970s, suggested a strong emphasis on geographical (availability) and financial (ability to pay) aspects. More recently, the literature has focused on less tangible aspects, such as cultural, educational, and socioeconomic issues, incorporating the element of acceptability into the notion of health access. The literature also shows that information provides the starting point for access to health, in association with health empowerment and literacy for health care decision-making. The study concludes that improvements in access to health and the guarantee of equity will not be achieved by initiatives focusing on health care systems alone, but rather will depend on intersectoral actions and social and economic policies aimed at eliminating income and education differences.
本文描述了健康可及性的四个维度——可获得性、可接受性、支付能力和信息，并将这些维度与指标相关联，探讨了可及性概念的复杂性。为研究这四个维度，我们使用了PubMed/MEDLINE、LILACS、SciELO以及世界卫生组织知识图书馆与信息网络（WHOLIS）数据库进行检索。我们还检索了《经济学人》《华盛顿邮报》和BBC网络等发行量较大的媒体。随着时间的推移，健康可及性的概念变得更加复杂。20世纪70年代进行的首次分析表明，重点强烈放在地理（可获得性）和财务（支付能力）方面。最近，文献关注的是较无形的方面，如文化、教育和社会经济问题，将可接受性因素纳入健康可及性概念中。文献还表明，信息是获得健康的起点，与健康赋权及医疗保健决策的健康素养相关联。该研究得出结论，仅关注医疗保健系统的举措无法实现健康可及性的改善和平等保障，而这将取决于旨在消除收入和教育差异的部门间行动以及社会和经济政策。
