LEARNING OUTCOMES
By the end of
this lecture students should be able to:
Explain the
concepts of access and equity in health care.
Differentiate
between accessibility and availability of health care.
Identify the
groups of people most of risk of poor access and the ways in which this factor
affects health equity.
Describe the
workforce issues contributing to poor access to healthcare in Australia.
ACCESS TO HEALTH CARE
CONCEPTS
Access to health care is
vital for improving health, preventing and managing disease, avoiding
preventable disability and premature death, and realizing health equity.
Multi-country epidemiological and
econometric analyses show that the health system independent of other factors
is a significant social determinant of health. Health systems that have adopted
a primary health care approach demonstrate positive population health outcomes1.
Global evidence also demonstrates that the health system is a social
determinant of health equity by promoting equity in access to health care1. Thus,
access to health care is pivotal to the performance of health care systems2.
However, access to health care is a complex
phenomenon, and there is no consensus on the definition of access to
health care. Access as a term has taken
on multiple meanings and dimensions depending on the disciplinary fields it
originated from(3-5) and the approaches used to study it.
However, there is agreement that access to health care services is located within a broader framework of institutional characteristics of a health care system that also include availability, acceptability, and quality of health care services.
Availability means that the socio-economic determinants of health and the functioning public health and health care facilities, goods and services, and programs are available in sufficient quantity.
Acceptability means that health facilities, goods, and services must conform to medical ethics standards and cultural appropriateness.
Quality means that health facilities, goods, and services must be scientifically and medically appropriate and of good quality.
REFERENCES:
1.Gilson L, Doherty J, Loewenson R, Francis V.
Challenging inequity through health systems. Final Report. WHO Commission on The Social Determinants Of Health and Knowledge Network
on Health Systems, 2007.
2.Levesque J-F, Harris MF, Russell G. Patient-centred access to health care:
conceptualising access at the interface of health systems and populations.
International Journal for Equity in Health. 2013;12(1):18.
3.Khan AA, Bhardwaj SM. Access to health care: a conceptual framework and its
relevance to health care planning. Eval Health Prof 1994 March 17(1):60-76.
4.Anderson JG. Health services utilization: framework and review. Health
Services Research. 1973 Fall;8(3):184-99. Fiedler JL. A review of the literature
on access and utilization of medical care with special emphasis on rural
primary care. Social Science & Medicine Part C. 1981 Sept;15(3):123-202.
5.Fiedler JL. A review of the literature on access and utilization of medical care
with special emphasis on rural primary care. Social Science & Medicine Part C.
1981 Sept;15(3):123-202.
IMPORTANCE OF HEALTH SYSTEMS AND ACCESS TO HEALTH CARE
With strong evidence from health systems
research showing that the health system is a significant social determinant of
health and equity, we begin by exploring the case example of maternal morbidity
and mortality to examine the importance of health systems to access to health
care.
EVOLVING CONCEPT OF ACCESS
Having explored the link between health systems and
access to health care, in this segment, we delve into the concept of access and the evolving
understanding of the concept of access over time. Is availability of health
care services the same as accessibility to health care? Does utilization of
healthcare imply access to health care? Check out this video for the answers.
BARRIERS TO ACCESS TO CARE
Between
the extreme definitions of access as availability of care and utilization of
health care, a new understanding of access emerged as a phenomenon that
involved the navigation of barriers. Barriers to health care may be at the
patient level (e.g., knowledge, linguistic barriers, socio-cultural factors) or the
health systems level ( e.g., policies that promote or impede access, availability of
resources). In this section, we explore a range of barriers at the patient and
health systems levels
WHAT IS ACCESSIBILITY TO HEALTH CARE AND EQUITY IN ACCESS
Having reviewed key
issues with some of the prevailing concepts of access to health care in the
public health literature, in this video we check out the right to health
definition of access to health care. The right to health definition of accessibility is outlined in General
Comment 14 (paragraph 12(b)) of the International
Covenant on Economic, Social and Cultural Rights. It identifies accessibility to health care in
terms of four inter-related dimensions including: non-discrimination, physical
accessibility, economic accessibility and information accessibility.
Additionally, with a view to understanding equitable access to health care, we highlight equity as health system’s ability to provide services according to needs and independent of capacity to pay.
Equity in access to health care is even more significant when we consider the World Health Organization’s estimates that about 100 million people are still being pushed into “extreme poverty” (living on $ 1.90 (1) or less a day) because they have to pay for health care.
THE SIGNIFICANCE OF INFORMATION ACCESS AND ACCESS TO MEDICAL RECORDS
The right to obtain, seek and impart health information and ideas is a key aspect of access. It helps individuals make informed choices about where, when, and how to obtain the health care they need. Part of information access is also the access to one’s medical records. This is especially important in the current context of segmentation where a single individual may have to visit several health care providers for different health needs.
Having access to medical records increases patient engagement and enables them to play an active role in their own care. They are also able to make informed decisions about their care.
Here we highlight the inspiring work of Regina Holliday - art teacher, artist, muralist, patient rights arts advocate, founder of the Walking Gallery. Regina has been on a relentless mission to highlight the importance of timely access of patients to their medical records.
This mission was inspired by her late husband Frederick Allen Holliday II’s experience with the health care system when he had kidney cancer and struggled to get appropriate care. Poor coordination of care, a lack of access to data, and medical errors marked the management of his care. Watch her tell her story here.
Check out her Walking Gallery here to see how she used a situation of adversity to make a difference in the lives of other patients and their families and amplify the call for greater clarity and transparency in medical records.
Regina can be reached at:
Blog: http://reginaholliday.blogspot.com
Grateful thanks to Ben Crosbie and Tessa Moran of Eidolon Films and Regina Holliday for permission to stream this video on Athyna. Regina shares more about
Apples to Apples here.
HEALTH SYSTEMS FACTORS IMPACTING ACCESS
Finally, in this last
segment, we review all the factors related to health systems which have an
important bearing on people’s access to health care.
DROP YOUR QUESTION
We welcome you now to drop your questions in the google form below. We will either address your query during the tutorial or communicate via email.
TOGGLE TIME
As always, toggle your memory now or later by taking the quiz below.
See you at the tutorials on Equity in
Access to Health Care! 