Domains of access to care framework by Levesque
Domain of access (health system)25 | Definition25 | Domain of access (Patient)25 | Definition25 |
1. Perceiving health needs and desire for care | |||
1a. Approachability | A person in need of health services can identify that service(s) exist, can be reached and have an impact on their health. | 1b. Ability to perceive | Determined by health literacy, knowledge about health, and beliefs related to health and sickness. |
2. Seeking healthcare | |||
2a. Acceptability | Cultural and social factors that influence acceptance of aspects of the service (eg, sex of providers) as well as the judged appropriateness of those seeking care (eg, cultural beliefs). | 2b. Ability to seek | An individual’s personal autonomy and capacity to choose whether to seek healthcare, knowledge about healthcare options, and rights that affect the expression of their intention to obtain healthcare. |
3. Reaching healthcare | |||
3a. Availability and accommodation | Health services, including both the physical space and the associated healthcare roles, can be reached in a timely manner. Involves the presence of sufficient health resources that can produce services. | 3b. Ability to reach | Individual mobility, transportation availability, occupational flexibility and knowledge of healthcare services that allow one to physically access healthcare services. |
4. Using healthcare | |||
4a. Affordability | Individuals’ economic capacity to expend resources and time to use appropriate healthcare services (varies based on service type). Depends on the prices of services, opportunity costs of accessing care. | 4b. Ability to pay | A capacity to generate economic resources through savings, income, or loans to pay for healthcare services without catastrophic expenditures of resources required for basic necessities. |
5. Healthcare consequences | |||
5a. Appropriateness | Service fit with individual needs, timeliness, amount of care placed in identifying correct treatments, and quality of services received both technically and interpersonally. | 5b. Ability to engage | Individuals’ participation and involvement in treatment decision-making, as determined by their capacity, motivation and commitment to participate in care to its completion. |