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Access as a policy-relevant concept in low- and middle-income countries

Published online by Cambridge University Press:  01 April 2009

DI MCINTYRE ,
MICHAEL THIEDE  and
STEPHEN BIRCH
DI MCINTYRE*
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa
MICHAEL THIEDE
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa
STEPHEN BIRCH
Affiliation:
Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, McMaster University and University of Manchester, UK
*
*Corresponding author: Di McIntyre, Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Health Sciences Faculty, Anzio Road, Observatory 7925, South Africa. Email: Diane.McIntyre@uct.ac.za
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Abstract:

Although access to health care is frequently identified as a goal for health care policy, the precise meaning of access to health care often remains unclear. We present a conceptual framework that defines access to health care as the empowerment of an individual to use health care and as a multidimensional concept based on the interaction (or degree of fit) between health care systems and individuals, households, and communities. Three dimensions of access are identified: availability, affordability, and acceptability, through which access can be evaluated directly instead of focusing on utilisation of care as a proxy for access. We present the case for the comprehensive evaluation of health care systems as well as the dimensions of access, and the factors underlying each dimension. Such systemic analyses can inform policy-makers about the ‘fit’ between needs for health care and receipt of care, and provide the basis for developing policies that promote improvements in the empowerment to use care.

Type
Special Section on Access to Health Care
Information
Health Economics, Policy and Law , Volume 4 , Issue 2 , April 2009 , pp. 179 - 193
Copyright
Copyright © Cambridge University Press 2009

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