Overcoming Barriers to Health Service Access: Influencing the Demand Side

International Programme, Centre for Health Economics, University of York, York, UK.
Health Policy and Planning (Impact Factor: 3.47). 04/2004; 19(2):69-79. DOI: 10.1093/heapol/czh009
Source: PubMed


Evidence suggests that demand-side barriers may be as important as supply factors in deterring patients from obtaining treatment. Yet relatively little attention is given, either by policy makers or researchers, to ways of minimizing their effect. These barriers are likely to be more important for the poor and other vulnerable groups, where the costs of access, lack of information and cultural barriers impede them from benefiting from public spending. Demand barriers present in low- and middle-income countries and evidence on the effectiveness of interventions to overcome these obstacles are reviewed. Demand barriers are also shown to be important in richer countries, particularly among vulnerable groups. This suggests that while barriers are plentiful, there is a dearth of evidence on ways to reduce them. Where evidence does exist, the data and methodology for evaluating effectiveness and cost-effectiveness is insufficient. An increased focus on obtaining robust evidence on effective interventions could yield high returns. The likely nature of the interventions means that pragmatic policy routes that go beyond the traditional boundaries of the public health sector are required for implementing the findings.

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    • "The third factor, geographical accessibility refers to the physical location of the health facility with respect to the location of the users. Examining these factors is essential because literature suggests that they influence population's health-seeking behaviour and impact health outcomes (Ensor and Cooper, 2004; Kerber et al., 2007;Peters et al.,2008; Arthur, 2012). For instance, Kerber et al. (2007) argue that long distances, financial constraints, poor transport, and poor quality care in health facilities are serious barriers limiting access to care for those who need it most. "
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    • "). Lower proportions of reported chronic conditions in the African surveys may reflect higher barriers to accessing care and differences in the structure and efficiency of health care delivery systems (Ensor and Cooper 2004; Sachs 2012). In addition, chronic diseases were more likely to be reported in women than men in the three surveys from low-income countries, an observation consistent with previous reports suggesting that in resource-constrained settings, women may carry an advantage in accessing care by the nature of their reproductive health needs and their predominant caregiver role in the family (Wagner et al. 2013; Rilkoff et al. 2013). "
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