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July 26, 1995

Access—Perceived or Real, and to What?

Author Affiliations

From the Department of Health Policy and Management, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.

JAMA. 1995;274(4):346-347. doi:10.1001/jama.1995.03530040074044

If health services have any value, then access to them must be important. The many research studies directed at demonstrating something so obvious as the value of access are testimony to concern about a health care system that does not ensure its universality.

See also p 305.

In this issue of The Journal, Bindman and colleagues1 report that there is a relationship between better perceived access to health services overall and lower hospitalization rates for conditions preventable by adequate ambulatory care (ambulatory care—sensitive conditions, or ACSCs), thus confirming findings of earlier studies. In California alone, the literature on the value of access is rich: Roemer et al2 demonstrated two decades ago that reductions in access led to higher hospitalization rates, and more recently the Rand Health Insurance Experiment and related studies3 also demonstrated adverse effects on outcome with reductions in access. Although there are other determinants of

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