• Academy Health: What do we mean when we talk about “access”?

    I spend a lot of time talking about the health care system. When I do, I usually reference three aspects of it: cost, quality, and access. Cost is pretty easy to define. Quality, less so. But access is often ignored. I get into the details in my latest post over at the AcademyHealth blog. Go read!


    • Another issue is the long patient waiting times. Too many doctors let too many patients wait in the waiting rooms too long. According to a Princeton economist, in year 2007 Americans aged 15 and older collectively spent 847 million hours waiting for medical services to be provided.

      Apply money value to that waiting time, and you have a huge hidden healthcare cost right there.

    • I’ve found the 5 A’s of access framework (Penchansky and Thomas, 1981) to be useful. More info here:


      To summarize, quoting directly from the article:

      Affordability is determined by how the provider’s charges relate to the client’s ability and willingness to pay for services.

      Availability measures the extent to which the provider has the requisite resources, such as personnel and technology, to meet the needs of the client.

      Accessibility refers to geographic accessibility, which is determined by how easily the client can physically reach the provider’s location.

      Accommodation reflects the extent to which the provider’s operation is organized in ways that meet the constraints and preferences of the client. Of greatest concern are hours of operation, how telephone communications are handled, and the client’s ability to receive care without prior appointments.

      Acceptability captures the extent to which the client is comfortable with the more immutable characteristics of the provider, and vice versa.These characteristics include the age, sex, social class, and ethnicity of the provider (and of the client), as well as the diagnosis and type of coverage of the client.

      Access (the overall concept) is no stronger than the weakest link of the chain. The wait times problem is about the availability bit. But as the country grows increasingly diverse, acceptability is going to be a larger issue. Accommodation has always been an issue for hourly workers (who probably have less flexible schedules).