Access to Care
Brian Biles and David Sandman
Access to health care—that is, an individual's ability to obtain services when needed—is a slippery concept, but one that lies at the heart of any health care system. Access is a by-product of thousands of decisions that range from policy judgments at the highest levels of government to choices made by individual patients on a daily basis. It depends on factors as diverse as insurance status, financing and delivery arrangements, availability of trained medical personnel, transportation, consumer information, and patient preferences. The many aspects of access to care have been categorized into those that predispose patients to use health services, those that depend on patients' level of illness and need for health care, and those that enable patients to get services on demand. 1
Changes occurring in the nation's health care system have placed concerns about access high on the list of priorities of both policymakers and the public. For Americans with insurance, the health care system they confront today is very different from that of the past. In particular, the rapid growth of managed care has brought renewed concern over patients' ability to access appropriate, highquality services when needed.
Managed care enrollment is increasing in every insurance market. Among employees of firms with two hundred or more workers,