Access

Access to health care, or its 'accessibility', is often regarded as an important determinant of the equity of a health care system, but the meaning and

Act Utilitarianism 3

significance of 'access' or 'accessibility' are nonetheless often left unclear. Insofar as it is important in equity it seems that it is cheapness of access that really matters, usually because the writer will have some notion underlying their concern for equity about the importance of meeting need, and access seems to be a precondition for having needs assessed in order that they might be met. Economists typically treat accessibility as a comprehensive term for 'price'; that is, any user monetary fee that is to be paid plus time and transport costs, waiting, and any other element that constitutes a 'barrier' whether or not that barrier takes a monetary form or can be converted into a monetary form. This emphasizes financial barriers to access. Other barriers may be physical, institutional or social. Some may be direct, others indirect. For example, access to insurance may be the only route to accessing health care itself. The following have all been found to be important practical barriers: the service was not there; it was too costly; transport was too difficult; the appointment time was not convenient; the language available was not suitable; the service was not known about; the social distance between clients and caregivers was too great. Absence of a service that is 'needed' or demanded is plainly a very real barrier.

Accessibility unimpeded to any significant extent by financial or other barriers is a characteristic of a health care system that is commonly desired or sometimes (as in Canada) required by statute.

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