Reuse of balloon catheters for coronary angioplasty.

Aday et al. (1) have defined access as those dimensions that describe the potential and actual, or realized, entry of a given population into the health care delivery system. Access to health care depends on many factors, such as race, culture, geographic location, financial and insurance status. For numerous reasons, equal access for all citizens to health care services in the United States has not yet been achieved. Kafka appropriately points out some of the differences between the Canadian and the U.S. health care systems and the fact that Canadians have "chosen" to emphasize access to primary care for all its citizens, apparently at the expense of "prolonged" waiting times for highly technical procedures. Certainly these issues must be addressed (as emphasized by Ryan [2]): How long a wait is too long? Are there negative consequences of too long a wait? Should the procedure in question be performed in the first place? However, I think that the fundamental issue is more a reflection of societal priorities. Do we as a society value health care services for all our citizens? Do we provide the financial resources so that all members of society, regardless of financial or insurance status, have access to primary and tertiary care in a timely manner? Canada has certainly taken a more committed role to universal access than has the United States. When the issue of what constitutes excessive waiting times are determined, it will be interesting to see whether or not Canadians will be willing to provide the financial support needed to develop and maintain a rapid-access primary and tertiary care system. For now, until we in the United States decide whether or not health care is a priority, the debate on how best to reform our health care system will continue with more unanswered questions than productive change.