Table 1

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.