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

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  • MCINTYRE, DI
  • THIEDE, MICHAEL
  • BIRCH, STEPHEN

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.

Suggested Citation

  • Mcintyre, Di & Thiede, Michael & Birch, Stephen, 2009. "Access as a policy-relevant concept in low- and middle-income countries," Health Economics, Policy and Law, Cambridge University Press, vol. 4(2), pages 179-193, April.
    • Handle: RePEc:cup:hecopl:v:4:y:2009:i:02:p:179-193_00
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    1. Whittaker, William & Birch, Stephen, 2012. "Provider incentives and access to dental care: Evaluating NHS reforms in England," Social Science & Medicine, Elsevier, vol. 75(12), pages 2515-2521.
    2. Gooding, Kate & Phiri, Mackwellings & Peterson, Ingrid & Parker, Michael & Desmond, Nicola, 2018. "Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why?," Social Science & Medicine, Elsevier, vol. 213(C), pages 190-198.
    3. Foster, Nicola & Vassall, Anna & Cleary, Susan & Cunnama, Lucy & Churchyard, Gavin & Sinanovic, Edina, 2015. "The economic burden of TB diagnosis and treatment in South Africa," Social Science & Medicine, Elsevier, vol. 130(C), pages 42-50.
    4. Nkolika Uguru & Obinna Onwujekwe & Chibuzo Uguru & Udochukwu Ogu & Chinenye Okwuosa & Chinyere Okeke, 2021. "Oral health-seeking behavior among different population groups in Enugu Nigeria," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-14, February.
    5. Nordin, Martin & Dackehag, Margareta & Gerdtham, Ulf-G., 2013. "Socioeconomic inequalities in drug utilization for Sweden: Evidence from linked survey and register data," Social Science & Medicine, Elsevier, vol. 77(C), pages 106-117.
    6. Lewando Hundt, Gillian & Alzaroo, Salah & Hasna, Fadia & Alsmeiran, Mohammed, 2012. "The provision of accessible, acceptable health care in rural remote areas and the right to health: Bedouin in the North East region of Jordan," Social Science & Medicine, Elsevier, vol. 74(1), pages 36-43.
    7. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, vol. 97(2-3), pages 209-216, October.
    8. Bereket Yakob & Busisiwe Purity Ncama, 2016. "Correlates of perceived access and implications for health system strengthening – lessons from HIV/AIDS treatment and care services in Ethiopia," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-19, August.
    9. Kathryn Schnippel & Naomi Lince-Deroche & Theo van den Handel & Seithati Molefi & Suann Bruce & Cynthia Firnhaber, 2015. "Cost Evaluation of Reproductive and Primary Health Care Mobile Service Delivery for Women in Two Rural Districts in South Africa," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-13, March.
    10. He, Jialin & Yi, Hongmei & Liu, Jian, 2016. "Urban green space recreational service assessment and management: A conceptual model based on the service generation process," Ecological Economics, Elsevier, vol. 124(C), pages 59-68.
    11. Kehinde Omotoso & Steven F. Koch, 2016. "South African Trends in Health Outcomes and Health-Related Behaviour: Evidence from Repeated Cross-Sectional Surveys," Working Papers 201650, University of Pretoria, Department of Economics.
    12. Ahuja, Richa & Tiwari, Geetam, 2021. "Evolving term “accessibility” in spatial systems: Contextual evaluation of indicators," Transport Policy, Elsevier, vol. 113(C), pages 4-11.
    13. Smith, Samantha & Walsh, Brendan & Wren, Maev-Ann & Barron, Steve & Morgenroth, Edgar & Eighan, James & Lyons, Seán, 2019. "Geographic profile of healthcare needs and non-acute healthcare supply in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS90.
    14. Kim, Tae Jun & Vonneilich, Nico & Lüdecke, Daniel & von dem Knesebeck, Olaf, 2017. "Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries," Social Science & Medicine, Elsevier, vol. 176(C), pages 158-165.

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