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Access to Care and Andersen Model
Access to Care and Andersen Model
Arindam [email protected]
2015-03-18
Access to Care and Andersen Model
Definitions of Access
Actual use of personal health services and
Also, Everything that facilitates or impedes their use
Link between health services systems and the populations theyserve.
Not Just visiting Health provider
Getting Right services at the Right time to promote improvedhealth outcomes
Access to Care and Andersen Model
Why is Access Important
Predicting use of health services
Promotion of social justice
Improving effectiveness
Improvement of efficient health service delivery
Access to Care and Andersen Model
A conceptual Model
Figure: Andersen Model
Access to Care and Andersen Model
Features of this Model
Major components of contextual characteristics are divided inthe same way as individual characteristics
Existing conditions that predispose are not directly responsiblefor use
Enabling conditions make easy/difficult use of services
Need == conditions that laypeople or health care providersrecognize as requiring medical treatment
Emphasizes contextual factors - importance of community,
Structure and process of providing care
Ultimate focus of the model remains on use of health services
Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors
Access to Care and Andersen Model
Contextual Predisposing
Demographic (age, gender, and marital status composition ofa community)
Question: How will a Society of Primarily older persons differin utilisation from a society where majority are youngerparents and children?
Social characteristics (how supportive or unsupportive are thecommunities where people live and work)
Question: How and Why might this affect health and accessto health services?
Relevant measures (educational level, ethnic composition,crime rate, employment)
Underlying Values and Beliefs
Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors
Access to Care and Andersen Model
Contextual Enabling
Health policies are authoritative decisions
Can be public policies made in the legislative/executive/orjudicial branch of government (MoH/DHB)
Can be Private Provider Based (GPs, Clinic Policies)
All levels from local to national
Access to Care and Andersen Model
Contextual Enabling Financial Factors
Resources available to pay for health services
Per capita community income and wealth (Deciles)
Incentives to purchase or provide services
Price of medical care and other goods and services, andmethod of compensating providers
Access to Care and Andersen Model
Contextual Organisational Factors
Amount and distribution of health services facilities andpersonnel
Supply of services in the community
Ratios of physicians and hospital beds to population
Waiting Time
Quality Control
Outreach Services
Access to Care and Andersen Model
Which of these Factors Can be Critical?
What Do You Think?
Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors
Access to Care and Andersen Model
Contextual Need Variables
Environmental need
Health-related measures of the physical environment
Housing, Water, Air, Others??
Injury and Death Rates (Motor Vehicle Accidents, FarmingAccidents)
Population Health Indices (infant mortality, birth rates,prevalence, disease-specific mortality)
Access to Care and Andersen Model
How do Contextual Variables Influence Health CareAccess? (What do the Arrows Tell?)
Figure: Andersen Model
Access to Care and Andersen Model
Individual Characteristics
Figure: Andersen Model
Access to Care and Andersen Model
Individual Predisposing
Demographic factors (Age, Gender, Other Biologicalimperatives)
Social factors (education, occupation, immigration, andethnicity)
Health beliefs (attitudes, values, and knowledge)
Access to Care and Andersen Model
Individual Enabling Characteristics
Income and wealth
Effective price of health care to the patient
Think: Regular Care, Care of Children, and Dental Care
Whether or not the individual has a regular source of care
What kind of Care (private doctor, community clinic,emergency room)
Transportation, waiting time for care
Access to Care and Andersen Model
Individual Perceived Need
How people view their own general health and functional state
How they experience and emotionally respond to signs andsymptoms
Discuss: To What Extent These Determine People‘s Access?
Access to Care and Andersen Model
What do You Think Explains Perceived Need?
Largely a social phenomenon
Ethnicity or education
Health beliefs (health attitudes, knowledge about health care,culture)
Access to Care and Andersen Model
Individual Evaluated Need
Doctorsor Nurses judgment
Objective measurement about a patients physical status andneed for medical care
Biological Perspective and Others Professional Expertise
Also social and professional (How??)
Access to Care and Andersen Model
What Would be the Key Difference between Perceived andEvaluated Need?
What do You think?
Perceived Need = Care Seeking Process, Adherence,Compliance
Evaluated Need = Actual Treatment Received and Outcomes
Access to Care and Andersen Model
Health Behaviours and Outcomes
Figure: Health Behaviours
Access to Care and Andersen Model
Personal /Individual Health Practices
Individual Health behaviours that influence health status (diet,exercise, smoking, addiction, self-care)
Behaviour of health providers interacting with patients(patient counselling, test ordering, prescribing patterns, andquality of provider-patient communication)
Are the Physicians/Nurses doing their bit? (Where EvidenceBased Health and Guidelines Come into play)
Access to Care and Andersen Model
Discuss: Can We Hypothesise Kind of Service Utilisation?
What kind of service utilisation do you think will be explainedby Need and Demographic Factors?
What kind of service utilisation do you think will be explainedby Social and Enabling Factors?
What Factors Do You Think will explain Ambulatory CareSeeking or OPD attendance?
Access to Care and Andersen Model
Types of Outcomes
Individual‘s Perceived health status.
Indicates extent to which a person can live a functional,comfortable, and pain-free life
Measures include reports of general perceived health status,activities of daily living
Access to Care and Andersen Model
Evaluated health status
Professional Judgment Based
Measures include tests of Physiology and Function
Access to Care and Andersen Model
Consumer Satisfaction
How individuals feel about the health care they receive.
Patient ratings of waiting time, travel time, communicationwith providers, and technical care received.
Access to Care and Andersen Model
What do You Think of the Feedback Loops in the Model?
Figure: Andersen Model
Access to Care and Andersen Model
Dimensions of Access to Care
tion shifted in the 1970s to concern for health care cost containment and creationof mechanisms to limit access to health care. Examples of policies designed to limitaccess are coinsurance, deductibles, utilization review, and the genesis of managedcare. In the 1980s and early 1990s, in competing with fee-for-service organizations,managed care enjoyed double-digit growth in profit margins.19 However, over timeits growth slowed, and managed care organizations came under considerablescrutiny regarding whether they limited needed services for their enrollees.
This managed care backlash led to a downward trend in health maintenanceorganization (HMO) enrollment in the mid-1990s through 2000; however, dur-ing the same time period Medicaid managed care continued to expand rapidly.20
In response to the managed care backlash and escalating health care costs, themajor commercial health plans turned from capitation and utilization review tohigh co-payments, shifting costs to consumers, tied networks with variable co-insurance, and medical management programs focusing on high-cost patients.21
Plans continue to experiment with new provider networks, payment systems, and
Improving Access to Care in America 11
Dimension Intended Improvement
To minimize the costs ofimproving outcomes from
health services useEfficient access6.
To improve the outcomes(health status, satisfaction)from health services use
Effective access5.
To reduce the influence of socialcharacteristics and enabling resources
on health services distributionInequitable access4.
Equitable accessTo ensure health services distribution
is determined by need3.
Realized access(use of services)
To monitor and evaluate policies toinfluence health services use2.
Potential access(enabling factors)
To increase or decreasehealth services use1.
FIGURE 1.2. THE POLICY PURPOSES OF ACCESS MEASURES.
Andersen.c01 12/5/06 2:33 PM Page 11
Figure: Andersen Model
Access to Care and Andersen Model
Equity of Access
Equitable/Inequitable Access is defined according to whichdeterminants of realized access are dominant in predictingutilization.
Equitable access occurs when demographic variables (age andgender), and need variables account for utilisation
Inequitable Access occurs when social characteristics andenabling resources such as ethnicity or income determine whogets medical care.
Access to Care and Andersen Model
How is NZ Doing?
Figure: Andersen Model
Access to Care and Andersen Model
What Type of Access Are We Discussing Here?
Figure: Andersen Model
Access to Care and Andersen Model
What Type of Access Are We Seeing Here?
Figure: Andersen Model
