Access in Health Services Research: the Battle of the Frameworks

Background: Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal.

Purpose: This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access.

Method: The article uses a critical review of the major works of the leading theorists in the field of access studies.

Discussion: Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care.

Conclusion: Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.