The limitations of confining measures of equity of access to financial variables are nowhere better illustrated than by those health services that must be combined with effective social services and public health planning for good results. Good prenatal care, for example, must be concerned with how the nutritional needs of the pregnant woman will be met. This service-integration feature, generally acknowledged for prenatal care, is also present in a set of topics that the committee identified for further development as access indicators. These topics represent access problems that may be amenable to solutions requiring close linkages among personal health care services, public health, and social services. In other words, the access problems of homeless people, migrants, people with disabilities, patients with the acquired immune deficiency syndrome (AIDS), and victims of domestic violence will not be solved with an insurance card alone. The complexity of the problems these people face taxes our current understanding of how to measure access barriers. Their problems require organizational solutions that include continuity of care, integration of services, and other subtle characteristics. Tracking these access problems will require measurement skills and methodologies that lie beyond our current capabilities.



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