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Outline the eight major factors that determine a country’s true access within a healthcare system.
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to:
1. Outline the eight major factors that determine a country’s true access within a healthcare system.
Reading Assignment Chapter 3: The Eight Factor Model for Evaluating True Access Chapter 9: The Healthcare System in Italy
Unit Lesson In this unit, we will explore Chapter 3 of the Lovett-Scott and Prather (2014) textbook. This chapter provides an introduction to the eight factors that serve as a framework to define whether or not true access to health care exists in a country or culture. Leaders and scholars have discussed this question for many years and tend to define access more narrowly than Lovett-Scott and Prather. Typically, access to care is determined by the ability to pay for the care through personal funds or by a third party payer (healthcare insurance, federal funding, etc.). Other writers include the ability to see a physician in a reasonable amount of time. Occasionally, the term “provider” is used instead of physician to denote the inclusion of physician extenders, such as advanced practice nurses and physician assistants. Regardless, the concept of true access to care extends further than the ability to obtain and pay for time with a licensed medical provider. The major elements of each factor are listed below: 1. Historical
– Traces how health and access to services have been defined historically – Describes how the healthcare system emerged – Defines the role of emergency room services – Observes the clinics and health centers providing care
2. Structure
– Defines the type of delivery system – Observes the health system’s infrastructure – Reviews health policies, roles, and responsibilities of medical professionals – Examines supply versus demand for services – Identifies the presence or absence of various structural barriers to services
3. Financing (Most difficult factors to address)
– Examines a nation’s ability to fund healthcare services – Describes the nation’s fiscal responsibilities and financing priorities – Determines where the majority of healthcare budget is spent – Includes a critical examination of long-term care, maternal care, and child care – Discusses technology and research, and emphasizes a system on curative care – Determines if the funding is private or public – Reviews the government’s role and provider’s compensation
Evaluating True Access to Care Using the Eight Factors Analysis
HCA 4303, Comparative Health Systems 2
4. Interventional – Determines the focus of care; primary care, acute care, restorative care, etc. – Observes if most care is provided in hospitals or community clinics – Reviews outcome-based systems for requirements and compensation – Determines the role of family and the community is healthcare delivery
5. Preventive
– Extent the healthcare delivery system preserves physical, mental, and social health – Reviews various known health risks and determines the amount of attention they receive
6. Resources (This is not financial resources as in Factor 3)
– Evaluates the availability and adequacy of human resources – Includes social and spiritual resources available – Observes the abundance or scarcity of both licensed and unlicensed healthcare workers
7. Major Health Issues
– Reviews key influences on health, such as illiteracy, poverty, culture, race, and gender – Describes public health challenges and initiatives and diseases prevalent – Observes the prevalence of and approaches to treating diseases – Assesses the level of independence the population shows in activities of daily living
8. Health Disparities
– Observes examples of unequal treatment – Links prevalence of diseases to social determinants (race, age, income, etc.)
Few authors place as much attention on the impact of historical, structural, and financial aspects of health care when addressing the complex issue of access. Even fewer discuss the issues of resources, health issues, and disparity. It could be argued that discussing whether or not a patient has transportation to and from an appointment or the ability to read the instructions printed in a certain language as a primary determinant of access to care. Where other scholars would see major health related issues and disparities as important social and economic issues, they would likely describe them as secondary or even tertiary factors greatly determined by gender and age as well as cultural, educational, and racial demographics. Location is another factor because rural areas typically have more difficulties with accessing care than urban areas. Yet, it is undetermined how any of those factors would automatically impact one’s ability to access health care when needed. Although the authors take somewhat of a political stance on health care, they do not bring politics to the forefront of the discussion. However, no discussion would be complete without acknowledging the importance that politics and law have on healthcare delivery. Health care is one of the most regulated professions, and lobbyists work hard to ensure that laws are passed that allow for the free flow of healthcare services without overly constraining medical professionals while simultaneously not limiting the amount of revenue earned. As we discussed in Unit I, many people view health care as a “calling,” but the bottom line is that it is also a business. Enjoy this unit as we explore the eight interrelated factors that contribute to the determination of true access to healthcare services. Each of the following units build upon this knowledge; so, ensure you understand at least the basics related to each one of the factors. This will prove invaluable as we explore numerous variables and intricacies noted in the eight countries we will study.
Reference Lovett-Scott, M., & Prather, F. (2014). Global health systems: Comparing strategies for delivering health
services. Jones and Bartlett Learning.
HCA 4303, Comparative Health Systems 3
Key Terms
1. Access 2. Disparity 3. Primary health care 4. Social determinants 5. True access