登入選單

返回Google圖書搜尋

Access as a Policy-Relevant Concept in Low- and Middle-Income Countries

Diane McIntyreMichael ThiedeStephen Birch

出版	SSRN, 2007
URL	http://books.google.com.hk/books?id=1CPbzwEACAAJ&hl=&source=gbs_api

註釋

Many low- and middle-income countries (LMICs) are far from achieving the Millennium Development Goals (MDGs). We believe that efforts to promote equitable access to health care are critical if health systems are to fulfill their potential in contributing to the achievement of the MDGs. However, in order to develop appropriate policies, there needs to be greater clarity on what access means and barriers to access need to be identified through detailed research. While there is consensus in the literature that access is a multi-dimensional concept, there is little agreement on what dimensions constitute access. In addition, there is frequently an exclusive focus on 'supply-side' issues when considering access. We argue, first, that access has both health system (supply-side) and household or individual (demand-side) aspects. Access is fundamentally about the interaction, or 'degree of fit', between the health system and the individual or household. Second, given the multitude of factors influencing access, it is necessary to identify key dimensions of access to act as 'entry points' for empirical investigation in a specific country context. The dimensions suggested by Penchansky in the late 1970s are a useful starting point, but we suggest modifying them into 3 key dimensions: - Availability - i.e. whether or not the appropriate health services are available in the right place and at the time that they are needed; - Affordability - i.e. the 'degree of fit' between health care costs and individuals' ability to pay; and - Acceptability - i.e. the relationships between providers' and patients' which are influenced by their attitudes towards and expectations of one another. While there are considerable inter-relationships between these dimensions, they are sufficiently distinct to allow their use as separate 'entry points' into a comprehensive empirical consideration of access. Such an evaluation would not focus exclusively on quantitative measures, but would require substantial qualitative assessment based on interviews and focus-group discussions with health care providers and the community. While we are not claiming that this is the 'only' way to conceptualize access, we do believe that in order to avoid the prevalent tendency to adopt utilization as a (inappropriate) proxy for access, a structured set of entry-points is needed to facilitate the direct evaluation of access. This paper will briefly explain the above conceptualization of access and will outline how an empirical investigation of access in the South African context is being undertaking, starting with these three dimensions of access and exploring the myriad of factors that underlie each dimension, and how this may inform policy initiatives to promote equitable access.