As is evident from the foregoing discussion, there are no clear demarcation lines among the types of barriers to access. They are highly interrelated—part of the complex processes involved in seeking health care and achieving good outcomes from that care. Nevertheless, they allow us to begin thinking about how measures of access (utilization and outcome) vary according to measures of equity (financing, structural, and personal/cultural factors). The number of uninsured, poor, and ethnic and racial minorities is growing. How well has the health care system adjusted to these changing realities?
In the next chapter the committee proposes a set of outcome and utilization indicators. The extent and direction of change in these indicators should reflect the efforts of policymakers to reduce barriers to care.
Aday, L. A., Anderson, R., and Fleming, G. 1980. Health Care in the U.S.: Equitable for Whom? Beverly Hills, Calif.: Sage Publications.
Andrews, F. 1989. Developing indicators of health promotion: Contribution from the social indicators movement. In: Health Promotion Indicators and Actions. S. B. Kar, ed. New York: Springer Publishing Co., pp. 29–49.
Berk, M. L., Bernstein, A., and Taylor, A. K. 1984. The use and availability of medical care in health manpower shortage areas. Inquiry 20(Winter):369–380.
Bureau of the Census, U.S. Department of Commerce. 1991. Statistical Abstract of the United States, 1991, 11th ed. Washington, D.C.: U.S. Government Printing Office, pp. 462–466.
DeNeufville, J. I. 1975. Social Indicators and Public Policy: Interactive Processes of Design and Application. Amsterdam: Elsevier.
Elinson, J. 1974. Toward sociomedical health indicators. Social Indicators Research 1:59–71.
Employee Benefits Research Institute. 1992. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1991 Current Population Study. An EBRI Special Report and Issue. Brief No. 123. Washington, D.C.: EBRI.
Enthoven, A. C. 1988. Managed competition: An agenda for action. Health Affairs 7(3):25–47.
Evans, R. G., and Stoddart, G. L. 1990. Producing health, consuming health care. Social Science and Medicine 31:1347–1364.
Fix, M., and Passel, J. 1991. The Door Remains Open. Recent Immigration to the United States and a Preliminary Analysis of the Immigration Act of 1990. Document No. PRIP–VI–14. Washington, D.C.: The Urban Institute.
Illich, I. 1975. Medical Nemesis: The Expropriation of Health. Toronto: Mclleland and Stewart.
Illsley, R. and Svensson, P. G., eds. 1990. Health Inequities in Europe. Special issue of Social Science and Medicine 31:229–236.
Lagasse, R., Humblet, P. C., Lenaerts, A., Godin, I., and Moens, G. F. 1990. Health and social inequities in Belgium. Social Science and Medicine 31:237–248.
Land, K. C. and Spilerman, S., eds. 1972. Social Indicator Models. New York: Russell Sage Foundation.