Access—Perceived or Real, and to What?

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 ofThe Journal, Bindman and colleagues¹report 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 al²demonstrated two decades ago that reductions in access led to higher hospitalization rates, and more recently the Rand Health Insurance Experiment and related studies³also demonstrated adverse effects on outcome with reductions in access. Although there are other determinants of