Qualita' ed accessibilita' delle cure

Qualità ed accessibilità
delle cure
Massimo Annicchiarico
Direttore Generale AUSL di Modena

• Accessibility is a property of health care
resources, of the population, or of some type
of relationship between the two
• The concept of “accessibility” is than just a
mental construct for grasping the essence of a
complex and indivisible reality
• Confounding factors (es) :
• Accessibility = availability
• Accessibility = use
• Accessibility is the degree of adjustment
between the characteristics of health care
resources and those of the population within
the process of seeking and obtaining care
Frenk, J. from Health Services Research: an anthology. WHO 1992
QUALITA’ E ACCESSO ALLE CURE
MASSIMO ANNICCHIARICO

Guidance for Policymakers - 2

Availability
Physical
existence of
health
resources
Use of services
Actual
consumption of
servicesEffective availability
Resistence
Utilization power
Services characteristics
Population characteristics

• The proof of access is use of the service, not
simply the presence of a facility
• But proof of accessibility is more than
demostrating use of a service
• In fact use of a health care service
compromises resource allocation, and affect
appropriate service use and impact,
suggesting that proof of accessibility is the use
of a service by those who need and would
benefit from it
• At the same time the concept of accessibility
reflects the complementarity of the
population/resources equation (degree of
adjustment) Donabedian A. Milbank Memorial Fund Quart 1972; 50: 103–154.

Resistance
Obstacles to seeking and
obtaining care
Utiliziation power
Capability of the
population to overcome
such obstacles
Degree of adjustement

The degree of fit between the consumer and the service
L
.
Penchansky R and Thomas JW. Med Care 1981; 19: 127–140

Iso-accessibility curves

• Accessibility : An accessible service is within reasonable proximity to the
consumer in term of time and distance
• Availability: An Available service has sufficient services and resources to meet
the volume and needs of the consumers and acommunities served
• Accettability: An accettable service responds to attitud of the provider and
the consumer regarding characteristics of the service and social or cultural
concern. For instance, a patient's willingness to seee a female doctor may
determine whether a service is acceptable or not
• Affordability: Affordable services examine the direct costs for both the service
and the consumer
• Adequacy: An adequate service is well organized to accept client, and client
are able tu use services. Considerations of adequacy include hours of operation
(after-hour services), referral or appointment systems, and facility structures (es.
wheelchair access)
• Awareness: A service maintains awareness through effective communication
and information strategies with relevant users (clinicians, patients, the broader
community), including consideration of the context and health literacy

Unmeet
needs
Universal
coverage
Public
health
expenditure
6 AS
Out
of
pocket
Equity
Beveridge

L
.

L
.
J. Cylus, I. Papanicolas / Health Policy 119 (2015) 1133–1144

EU 27 avarage

Sara Allin et all; European Commission Directorate-General "Employment, Social
Affairs and Equal Opportunities"
Unit E1 - Social and Demographic Analysis 2007,

Everett Rogers

L
.
Mass deprivation
Marginal exclusion
Victora et a,l,AJPH April 2018, Vol 108, No. 4

L
.
Victora et a,l,AJPH April 2018, Vol 108, No. 4

Horizontal equity
Accessibility
High complexity
intervention
Low complexity
intervention

guaranteed supplementary desirable
garanzie
orizontal equity
verticalequity

Donabedian A. Milbank Memorial Fund Quart 1972; 50: 103–154.
• Accessibility is not an exclusive feature of one health system or another (BBB)
• Accessibility dont'strictly correlate with health expenditure (public or OOP)
• Out of pocket expenditure don't strictly correlate with “universal coverage”
• Consider the population's power as a fixed factor, and the specific obstacles of
the resources variable in the short term, whereas population's power need long-
term intervention
• Narrowing the concept of accessibility, we exclude «continuity of care» that is a
important need for chronic patients

Donabedian A. Milbank Memorial Fund Quart 1972; 50: 103–154.
• Consider the population's power as a fixed factor, and the specific obstacles of
the resources variable in the short term, whereas population's power need long-
term intervention
• Patients must be involved in defining indicators on access and health system &
performance assessment. Patient organisations should be involved meaningfully
in these projects, according to existing good practices/recommendations.
• Consider awarness (patient empowerment, health literacy, education)
• As focused strategies for increasing intervention coverage are implemented
globally, the inverse equity hypothesis can provide policy guidance for minimizing
inequalities.
QE CURE

Isaiah Berlin “Due concetti di liberta”
“ Se diamo a lupi ed agnelli la stessa libertà e non c’è
un’autorità che proibisce ai primi di azzannare i secondi,
è chiaro che per questi ultimi la libertà è solo una beffa”
Isaiah Berlin : Due liberta’

Qualita' ed accessibilita' delle cure

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Qualita' ed accessibilita' delle cure

Similar to Qualita' ed accessibilita' delle cure (20)

More from Massimo Annicchiarico

More from Massimo Annicchiarico (8)

Recently uploaded

Recently uploaded (20)

Qualita' ed accessibilita' delle cure

Editor's Notes