This chapter explores access to health care – the timely availability of professional health services to prevent, diagnose and treat illnesses and to preserve or improve the health of individuals – and its consequences.
Access varies between and within countries. The challenge of providing access in relation to both communicable and non-communicable diseases is formidable [1].
The ethical context in which access is considered includes the human rights and social justice concepts of ‘a right to health care’ and ‘equity of access.’ Conscious that these concepts differ from country to country, we offer working definitions.
Providing access is complex. Which groups or organisations are responsible for provision (the enablers), and how might access be financed? More people are living longer, with long-term co-morbidities. The disease burden in developing countries is shifting. By 2020, non-communicable diseases are likely to account for approximately 70% of preventable, premature deaths [2]. How much care should be provided, and at what level? Is access confined to a minimum set of services or does it include more expensive and innovative treatments?
Countries and their governments vary in their political and social attitudes to access. Those with a strong social welfare agenda might focus attention and budgets on social factors such as education and social welfare; these not only determine health, but also access to care. Others, regarding health care as the individual’s concern, might give these factors less weight.
Despite this complexity and much national variation, access depends, in general, most often on good primary care, public investment and political will, availability of data to guide resourcing decisions, and the development of a well-trained, integrated workforce with appropriate supporting infrastructure.