Access to healthcare

Abstract

Access to healthcare is concerned with the processes of gaining entry to the healthcare system. Analysis of access focuses on inequality and inequity in the availability and use of health services. In order to address global inequalities in access to healthcare, international organizations have promoted access to healthcare as a human right. This is linked to the ideal of universal health coverage, with shared funding of some or all healthcare for everyone, as a key strategy for achieving this. At a national level, rational strategies for resource allocation and priority setting are used to promote equity of access in terms of equal access for equal need, but historical inequalities based on the ‘inverse care law’ have been resistant to change. In health systems led by primary care, access to a general practitioner (GP) tends to reduce inequalities in ‘entry’ access to the health system, but the gatekeeping role of GPs may contribute to the development of inequalities of ‘in-system’ access. Wide variations in the utilization of both primary and secondary care services are indicative of access inequalities, but these variations may sometimes reflect clinical uncertainty or poor-quality care. Access inequalities may also arise from personal, social, and cultural barriers experienced by patients in accessing healthcare. These barriers typically represent more severe obstacles for marginalized groups in the population. Promoting equity means ensuring that services are responsive and acceptable to all groups, including those with stigmatized conditions.