Access to Healthcare

As Exhibit 3.1 indicates, access to care has many dimensions: geographic, physical, temporal, sociocultural, and financial. Geographic access is influenced by where the care seeker lives in relationship to where the provider practices. A full range of medical services is unlikely to be available in a coastal village in Alaska, a mountain mining town in Nevada, or a rural farming community in the Midwest, for example, even though the physician to patient ratios suggest that physician supply is adequate to serve these populations. Medical care is most likely to be found where a population base and related services to support it exist. Those who live outside such areas may have to travel considerable distances, often over difficult terrain and through imposing weather, to reach care. Transportation is a factor in geographic access. Public transportation systems do not serve all areas where people live, and private transportation may not be available to the care seeker.

Physical access to care is influenced by the care seeker’s physical mobility and mental competence in reaching a provider, as well as by the ease of access to the provider’s facility. Today’s system of health services usually requires the care seeker to go to the provider. In-home services, although growing, still do not typically include home visits by physicians for routine care.

Ease of access to a provider’s facility has been assisted by the Americans with Disabilities Act of 1990, which recommends appropriate access and imposes sanctions for noncompliance. Another potential way to increase access to a provider is through the use of telemedicine and through remote monitoring of chronic diseases. Such mechanisms have not yet begun to reach their full potential (Barton et al. 2007).

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Temporal access may be inhibited when, because of an inflexible work schedule, the unavailability of care for young and old dependents, or other time constraints,...