Equity of Access to Quality of Care in Family Medicine

Abstract

Accessibility is an important characteristic of primary health care contributing in large part to its success in making health care more efficient and equitable. Countries which have comprehensive primary health care systems have lower costs and generally healthier populations [1, 2]. To get the benefits of PHC services, people need to be able to access and use them. Access to primary health care has also been proposed as a strategy to address health inequities [3]. Access varies in different contexts. In some countries, there are major barriers to access to basic primary health care. In others, even though there is reasonably equitable access to primary health care, there are inequitable barriers to accessing quality or comprehensive care and to subsequent referral services, sometimes referred to as access in care. "Inverse Care" is where persistent barriers to access exist for people from disadvantaged backgrounds, despite their higher need [4]. Where such inverse care persists, health care can inadvertently become part of the system that sustains unjust inequities in health-making action at this level imperative [5]. Access arises from a complex interplay between patient, provider, and system factors. Accessibility can be defined as the opportunity or ease with which consumers or communities are able to use services in proportion to their need [6]. Patient factors include economic resources, health literacy, and attitudes. Provider and system factors are closely linked and have been summarised by 5As originally described by Pechansky and others [7, 8] as follows. Availability. of a sufficient volume of services (including professionals, facilities, and programmes) to match the needs of the population and the location of services close to those needing them. This is underpinned by the distribution of the health workforce. Affordability. (cost versus consumers' ability to pay, impact of health care costs on socioeconomic circumstances of patients). This is influenced by the way in which government funds primary health care and the regulation of and access to the health insurance. Accommodation. the delivery of services in such a manner that those in need of them can use them without difficulty (e.g., appropriate hours of opening and accessible buildings). Appropriateness. to socioeconomic, educational, cultural, and linguistic needs of patients. Acceptability. in terms of consumer attitudes and demands. This special issue presents a number of studies of the complex interplay of all these patient, provider, and system factors. Two papers deal with access to mental health services. In a qualitative study in northwestern England, K. Bristow et al. in "Help seeking and access to primary care for people from "hard-to-reach" groups with common mental health problems" identify four factors which influence access to mental health care by "hard-to-reach groups" including patient conceptualisation of health care and their help seeking behaviours as well as barriers such as lack of time and the challenge of negotiating a range of services. Patients hoped for a GP willing to listen and refer or liaise with specialist services but did not always get this due to lack of GP time and linkages with social care and nongovernment organizations, something that other research has demonstrated to be