Access to Health Services
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Access to and utilization of health services leads to improved physical health, which promotes power and autonomy. Lack of access to health services can lead to unmet health needs for children, adolescents, and adults.

Evidence of the Relationship between Predictor and Related Outcomes

  • Having a usual source of care affects children’s health outcomes. Compared with other children, those with a usual source of care had fewer unmet needs, including unmet medical, dental, and prescription needs; problems getting care, tests or treatment; delayed urgent care; problems in seeing a specialist; and other unmet treatment needs. Among children with health insurance, those with no usual source of care had higher rates of unmet needs than those who had one (Devoe et al. 2012).
  • Access to health care moderates the prevalence and severity of chronic conditions because regular health check-ups help prevent illnesses. Bindman and colleagues (1995) found that better access was associated with reduced hospitalization rates for asthma, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and diabetes.
  • Access to health services is related to health status and use of health services. Ettner (1996) shows that having a usual source of medical care is strongly correlated with earlier receipt of preventive services, such as pap smears, breast exams, and mammograms. Early detection of preventive diseases can lead to better future health, thus relieving a person of a significant amount of stress and freeing them from the confines of a hospital or from additional expenses for medical care.
  • A study on asthma and health services looked at children who had asthma in families both experiencing and not experiencing poverty. The study found that children with asthma in families experiencing poverty had 40 percent fewer doctor visits, 40 percent more hospitalizations, and an additional seven days in bed because of their asthma (Halfon and Newacheck 1993).
  • Research points to evidence of racism historically and within the current health care system in the United States (Peek et al. 2010; Vyas, Eisenstein, and Jones 2020; Washington 2016). Racism affects access to and utilization of health care in many ways. For example, fewer hospitals are built in areas where people of color live, and providers often neglect to listen to or believe patients of color, offer subpar pain management to patients of color, and design treatment plans based on research of primarily white subjects. Which hospitals people have geographic and monetary access to, as well as the hospitals they generally trust and choose to access, are affected by segregation caused by racist practices (Kowalczyk, Wallack, and Dungca 2019). Research also demonstrates that racism in health care is associated with less take-up of preventive care and affects other types of health service use, such as when people delay or decline to seek care and or decline to adhere to a treatment regimen (Ben et al. 2017; Peek et al., 2010).
  • Freeman and colleagues (2008) conducted a systematic review of 14 empirical studies that look at the causal relationship between health insurance and health care use and other health outcomes and find that having health insurance had substantial effects on the use of physician services, preventive services, self-reported health status, and mortality conditional on injury and disease.

How Investments Can Influence the Predictor at State or Local Levels

Local or state governments could provide local health insurance navigators to help people sign up and access Medicaid or Affordable Care Act insurance plans (Williams et al. 2017). The Affordable Care Act has been associated with improvements in having a usual source of care, greater ease in accessing medication, and reductions in delaying or forgoing necessary care (Kominski, Nonzee, and Sorensen 2017).

Evidence suggests that fear of immigration enforcement has a negative effect on utilization of health services (specifically postnatal care) by Latinx immigrants. Although immigration policy is outside the purview of local governments, local policy that educates community members of their rights to health services and addresses existing barriers (e.g., lack of identification) can increase health service utilization among this Latinx immigrants (Rhodes et al, 2015).


The primary reference is marked with an asterisk.

Ben, Jehonathan, Donna Cormack, Ricci Harris, and Yin Paradies. 2017. “Racism and Health Service Utilization: A Systematic Review and Meta-analysis.” PloS One 12 (12): e0189900.

Bindman, Andrew B., Kevin Grumbach, Dennis Osmond, Miriam Komaromy, Karen Vranizan, Nicole Lurie, John Billings, and Anita Stewart. 1995. “Preventable Hospitalizations and Access to Health Care.” Journal of the American Medical Association 274 (4): 305–11.

Ettner, Susan Louise. 1996. “The Timing of Preventive Services for Women and Children: The Effect of Having a Usual Source of Care.” American Journal of Public Health 86 (12): 1748–54. doi:10.2105/ajph.86.12.1748

Freeman, Joseph D., Srikanth Kadiyala, Janice F. Bell, and Diane P. Martin. 2008. “The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies.” Medical Care 46 (10): 1023–32.

Halfon, Neal, and Paul W. Newacheck. 1993. “Childhood Asthma and Poverty: Differential Impacts and Utilization of Health Services.” Pediatrics 91 (1): 56–61.

Kominski, Gerald F., Narissa J. Nonzee, and Andrea Sorensen. 2017. “The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations.” Annual Review of Public Health 38 (1): 489–505.

Kowalczyk, Liz, Todd Wallack, Nicole Dungca, Akilah Johnson, Andrew Ryan, Adrian Walker, and Patricia Wen. 2019. “Color Line Persists, in Sickness as in Health.” Boston Globe, December 12.

Peek, Monica E., Angela Odoms-Young, Michael T. Quinn, Rita Gorawara-Bhat, Shannon C. Wilson, and Marshall H. Chin. 2010. “Racism in Healthcare: Its Relationship to Shared Decision-Making and Health Disparities: A Response to Bradby.” Social Science & Medicine 71 (1): 13.

Rhodes, Scott D., Lilli Mann, Florence M. Simán, Eunyoung Song, Jorge Alonzo, Mario Downs, Emma Lawlor, et al. 2015. “The Impact of Local Immigration Enforcement Policies on the Health of Immigrant Hispanics/Latinos in the United States.” American Journal of Public Health 105 (2): 329–37.

*Devoe, Jennifer E., Carrie J. Tillotson, Lorraine S. Wallace, Sarah E. Lesko, and Heather Angier. 2012. “The Effects of Health Insurance and a Usual Source of Care on a Child's Receipt of Health Care.” Journal of Pediatric Health Care 26 (5): e25–35. 

Vyas, Darshali A., Leo G. Eisenstein, and David S. Jones. 2020. “Hidden in Plain Sight—Reconsidering the Use of Race Correction in Clinical Algorithms.” New England Journal of Medicine 383: 874–82.

Washington, Harriet A. 2006. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Doubleday Books.

Williams, Malcolm V., Laurie T. Martin, Christian Lopez, and Courtney Armstrong. 2017. “Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Illinois.” RAND Health Quarterly 6 (4): 2

Healthy Environment and Access to Good Health Care

Related outcome: Good physical health

Mobility principle engaged: Power and autonomy

An illustration of a mother and child walking while holding hands