Equity of Access to Quality of Care in Family Medicine

Accessibility is an important characteristic of primary health care contributing in large part to its success in making health care more efficient and equitable. Countries which have comprehensive primary health care systems have lower costs and generally healthier populations [1, 2]. To get the benefits of PHC services, people need to be able to access and use them. Access to primary health care has also been proposed as a strategy to address health inequities [3]. Access varies in different contexts. In some countries, there are major barriers to access to basic primary health care. In others, even though there is reasonably equitable access to primary health care, there are inequitable barriers to accessing quality or comprehensive care and to subsequent referral services, sometimes referred to as access in care. “Inverse Care” is where persistent barriers to access exist for people from disadvantaged backgrounds, despite their higher need [4]. Where such inverse care persists, health care can inadvertently become part of the system that sustains unjust inequities in health-making action at this level imperative [5]. Access arises from a complex interplay between patient, provider, and system factors. Accessibility can be defined as the opportunity or ease with which consumers or communities are able to use services in proportion to their need [6]. Patient factors include economic resources, health literacy, and attitudes. Provider and system factors are closely linked and have been summarised by 5As originally described by Pechansky and others [7, 8] as follows.