The document discusses the Andersen Model of health care access. The model conceptualizes access as being determined by population characteristics (contextual and individual factors) that predispose people to use services or enable/impede their use. These include demographic, social, health beliefs, and enabling resources factors. The model also considers people's need (perceived and evaluated by professionals) and how this influences health behaviors and outcomes. It provides a framework for examining equitable access to care based on need rather than social characteristics or enabling resources.

1. Access to Care and Andersen Model
Access to Care and Andersen Model
Arindam Basu
arindam.basu@canterbury.ac.nz
2015-03-18

2. 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 they
serve.
Not Just visiting Health provider
Getting Right services at the Right time to promote improved
health outcomes

3. 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

4. Access to Care and Andersen Model
A conceptual Model
Figure: Andersen Model

5. Access to Care and Andersen Model
Features of this Model
Major components of contextual characteristics are divided in
the same way as individual characteristics
Existing conditions that predispose are not directly responsible
for use
Enabling conditions make easy/difficult use of services
Need == conditions that laypeople or health care providers
recognize 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

6. Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors

7. Access to Care and Andersen Model
Contextual Predisposing
Demographic (age, gender, and marital status composition of
a community)
Question: How will a Society of Primarily older persons differ
in utilisation from a society where majority are younger
parents and children?
Social characteristics (how supportive or unsupportive are the
communities where people live and work)
Question: How and Why might this affect health and access
to health services?
Relevant measures (educational level, ethnic composition,
crime rate, employment)
Underlying Values and Beliefs

8. Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors

9. Access to Care and Andersen Model
Contextual Enabling
Health policies are authoritative decisions
Can be public policies made in the legislative/executive/or
judicial branch of government (MoH/DHB)
Can be Private Provider Based (GPs, Clinic Policies)
All levels from local to national

10. 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, and
method of compensating providers

11. Access to Care and Andersen Model
Contextual Organisational Factors
Amount and distribution of health services facilities and
personnel
Supply of services in the community
Ratios of physicians and hospital beds to population
Waiting Time
Quality Control
Outreach Services

12. Access to Care and Andersen Model
Which of these Factors Can be Critical?
What Do You Think?

13. Access to Care and Andersen Model
Contextual Factors
Figure: Contextual Factors

14. 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, Farming
Accidents)
Population Health Indices (infant mortality, birth rates,
prevalence, disease-specific mortality)

15. Access to Care and Andersen Model
How do Contextual Variables Influence Health Care
Access? (What do the Arrows Tell?)

16. Access to Care and Andersen Model
Individual Characteristics
Figure: Andersen Model

17. Access to Care and Andersen Model
Individual Predisposing
Demographic factors (Age, Gender, Other Biological
imperatives)
Social factors (education, occupation, immigration, and
ethnicity)
Health beliefs (attitudes, values, and knowledge)

18. 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

19. 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 and
symptoms
Discuss: To What Extent These Determine People‘s Access?

20. 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)

21. Access to Care and Andersen Model
Individual Evaluated Need
Doctorsor Nurses judgment
Objective measurement about a patients physical status and
need for medical care
Biological Perspective and Others Professional Expertise
Also social and professional (How??)

22. Access to Care and Andersen Model
What Would be the Key Difference between Perceived and
Evaluated Need?
What do You think?
Perceived Need = Care Seeking Process, Adherence,
Compliance
Evaluated Need = Actual Treatment Received and Outcomes

23. Access to Care and Andersen Model
Health Behaviours and Outcomes
Figure: Health Behaviours

24. 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, and
quality of provider-patient communication)
Are the Physicians/Nurses doing their bit? (Where Evidence
Based Health and Guidelines Come into play)

25. Access to Care and Andersen Model
Discuss: Can We Hypothesise Kind of Service Utilisation?
What kind of service utilisation do you think will be explained
by Need and Demographic Factors?
What kind of service utilisation do you think will be explained
by Social and Enabling Factors?
What Factors Do You Think will explain Ambulatory Care
Seeking or OPD attendance?

26. 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

27. Access to Care and Andersen Model
Evaluated health status
Professional Judgment Based
Measures include tests of Physiology and Function

28. Access to Care and Andersen Model
Consumer Satisfaction
How individuals feel about the health care they receive.
Patient ratings of waiting time, travel time, communication
with providers, and technical care received.

29. Access to Care and Andersen Model
What do You Think of the Feedback Loops in the Model?
Figure: Andersen Model

30. Access to Care and Andersen Model
Dimensions of Access to Care
tion shifted in the 1970s to concern for health care cost containment and creation
of mechanisms to limit access to health care. Examples of policies designed to limit
access are coinsurance, deductibles, utilization review, and the genesis of managed
Improving Access to Care in America 11
Dimension Intended Improvement
To minimize the costs of
improving outcomes from
health services use
Efficient access6.
To improve the outcomes
(health status, satisfaction)
from health services use
Effective access5.
To reduce the influence of social
characteristics and enabling resources
on health services distribution
Inequitable access4.
Equitable access
To ensure health services distribution
is determined by need
3.
Realized access
(use of services)
To monitor and evaluate policies to
influence health services use
2.
Potential access
(enabling factors)
To increase or decrease
health services use
1.
FIGURE 1.2. THE POLICY PURPOSES OF ACCESS MEASURES.
Andersen.c01 12/5/06 2:33 PM Page 11
Figure: Andersen Model

31. Access to Care and Andersen Model
Equity of Access
Equitable/Inequitable Access is defined according to which
determinants of realized access are dominant in predicting
utilization.
Equitable access occurs when demographic variables (age and
gender), and need variables account for utilisation
Inequitable Access occurs when social characteristics and
enabling resources such as ethnicity or income determine who
gets medical care.

32. Access to Care and Andersen Model
How is NZ Doing?
Figure: Andersen Model

33. Access to Care and Andersen Model
What Type of Access Are We Discussing Here?
Figure: Andersen Model

34. Access to Care and Andersen Model
What Type of Access Are We Seeing Here?
Figure: Andersen Model