Institut national de santé publique du Québec, 190 Crémazie Est, Montréal, QC H2P1E2, Canada.
Int J Equity Health. 2013 Mar 11;12:18. doi: 10.1186/1475-9276-12-18.
Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services.
A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework.
Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.
This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.
在全球范围内，获得医疗服务是医疗保健系统绩效的核心。然而，正如不同作者对这一概念的多种解释所表明的那样，获得医疗服务仍然是一个复杂的概念。本文旨在提出一个描述广泛维度和决定因素的医疗服务可及性概念，这些维度和决定因素整合了需求和供给方因素，并使医疗服务可及性的运作能够贯穿于获得医疗服务和受益于医疗服务的整个过程。
对已发表的关于获得医疗服务的概念化文献进行了综合分析。最常被引用的框架被用作开发修订概念框架的基础。
在这里，我们将获得医疗服务的机会视为识别医疗需求、寻求医疗服务、到达、获得或使用医疗服务以及实际满足服务需求的机会。我们将可及性概念化为五个维度：1）可接近性；2）可接受性；3）可用性和适应性；4）可负担性；5）适宜性。在这个框架中，五个相应的人群能力与可及性维度相互作用，产生获得医疗服务的机会。五个相应的人群能力维度包括：1）感知能力；2）寻求能力；3）到达能力；4）支付能力；5）参与能力。
本文解释了这种医疗服务可及性概念的全面性和动态性，并确定了相关的决定因素，这些决定因素可以从多层次的角度影响获得医疗服务的机会，其中包括与卫生系统、机构、组织和提供者相关的因素，以及个人、家庭、社区和人口层面的因素。
