Thomas J W, Penchansky R
Med Care. 1984 Jun;22(6):553-68. doi: 10.1097/00005650-198406000-00006.
Underlying the continuing emphasis on access by health services researchers and policymakers is the assumption that patients having poorer access will receive less than appropriate health care, other things being equal. However, recent research results typically have not supported this assumption, and the nature and importance of relationships between access and use still remain unclear. Most published studies have sought to define general relationships that are descriptive of the behavior of all patients in a population facing access problems. The authors use interview data to show that significant relationships between satisfaction with access and use of services can be found if segments of the population, homogeneous in terms of age, sex, or other characteristics, are considered separately. This approach is based on the assumption that dissatisfaction with a particular dimension of access may be salient for some groups of patients but not others, and it is consistent with the view that patients' beliefs and perceptions are important determinants of health behavior.
卫生服务研究人员和政策制定者持续强调医疗服务可及性，其背后的假设是，在其他条件相同的情况下，医疗服务可及性较差的患者获得的医疗保健会低于适当水平。然而，近期的研究结果通常并不支持这一假设，可及性与医疗服务利用之间关系的性质和重要性仍不明确。大多数已发表的研究试图界定描述面临可及性问题人群中所有患者行为的一般关系。作者利用访谈数据表明，如果按年龄、性别或其他特征划分的人群细分部分分别进行考量，就会发现可及性满意度与服务利用之间存在显著关系。这种方法基于这样一种假设，即对特定可及性维度的不满可能对某些患者群体很突出，但对其他群体则不然，并且它与患者的信念和认知是健康行为的重要决定因素这一观点相一致。
