Objective: This systematic review aims to assess the use and implementation of the Behavioral Model of Health Services Use developed by Ronald M. Andersen in recent studies explicity using this model.

Methods: A systematic search was conducted using PubMed in April 2011. The search strategy aimed to identify all articles in which the Andersen model had been applied and which had been published between 1998 and March 2011 in English or German. The search yielded a total of 328 articles. Two researchers independently reviewed the retrieved articles for possible inclusion using a three-step selection process (1. title/author, 2. abstract, 3. full text) with pre-defined inclusion and exclusion criteria for each step. 16 studies met all of the inclusion criteria and were used for analysis. A data extraction form was developed to collect information from articles on 17 categories including author, title, population description, aim of the study, methodological approach, use of the Andersen model, applied model version, and main results. The data collected were collated into six main categories and are presented accordingly.

Results: Andersen’s Behavioral Model (BM) has been used extensively in studies investigating the use of health services. The studies identified for this review showed that the model has been used in several areas of the health care system and in relation to very different diseases. The 1995 version of the BM was the version most frequently applied in the studies. However, the studies showed substantial differences in the variables used. The majority of the reviewed studies included age (N=15), marital status (N=13), gender/sex (N=12), education (N=11), and ethnicity (N=10) as predisposing factors and income/financial situation (N=10), health insurance (N=9), and having a usual source of care/family doctor (N=9) as enabling factors. As need factors, most of the studies included evaluated health status (N=13) and self-reported/perceived health (N=9) as well as a very wide variety of diseases. Although associations were found between the main factors examined in the studies and the utilization of health care, there was a lack of consistency in these findings. The context of the studies reviewed and the characteristics of the study populations seemed to have a strong impact on the existence, strength and direction of these associations. 

Conclusions: Although the frequently used BM was explicitly employed as the theoretical background for the reviewed studies, their operationalizations of the model revealed that only a small common set of variables was used and that there were huge variations in the way these variables were categorized, especially as it concerns predisposing and enabling factors. This may stem from the secondary data sets used in the majority of the studies, which limited the variables available for study. Primary studies are urgently needed to enrich our understanding of health care utilization and the complexity of the processes shown in the BM.

Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011.

http://www.omega3galil.com/wp-content/uploads/2013/10/Potential-role-of-sugar-fructose-in-the-epidemic-of-hypertension-obesity-diabetes-kidney-disease-and-cv-disease.pdf

Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease

Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.92.9.1421

Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting

29 October 2015 8:19 AM 3 This chapter presents basic trends as well as research and policy issues related to health care access. We define access as actual use of personal health services and everything that facilitates or impedes their use. It is the link between health services systems and the populations they serve. Access means not only visiting a medical care provider but also getting to the right services at the right time to promote improved health outcomes. Conceptualizing and measuring access is the key to understanding and making health policy in a number of ways: (1) predicting use of health services, (2) promoting social justice, and (3) improving effectiveness and efficiency of health service delivery. The chapter presents a conceptual framework for understanding the multiple dimensions of access to medical care. The various types of access are considered and related to their policy purposes. Examples of key access measures are given, and trend data are used to track changes that have occurred over time in these access indicators. The chapter addresses the questions: Is access improving or declining in the United States? for whom? according to what measures? It concludes by discussing future access indicators and research directions.

Improving Access to Care in America: Individual and Contextual Indicators.

Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services.

Racial and ethnic groups in the United States continue to experience major disparities in health status. Compared to the majority non-Latino white population, racial and ethnic minorities bear a disproportionate burden of mortality and morbidity across a wide range of health conditions. These disparities in health status are compounded by reduced access to health care services. Although many factors affect health status, the lack of health insurance and other barriers to obtaining health services diminish racial and ethnic minorities’ utilization of preventive services and medical treatments that could reduce disease and contribute to improved health status. This report examines disparities in health insurance coverage and access to physician services across major racial and ethnic groups and subgroups in the United States. To examine the relationship of ethnicity and other factors on health insurance coverage and on access to health services, we analyzed two population-based surveys, the Current Population Survey and the National Health Interview Survey.

/pdf/racial-and-ethnic-disparities-in-access-to-health-insurance-1vzoth8it3.pdf

Racial and Ethnic Disparities in Access to Health Insurance and Health Care

This paper considers the impact of community-level variables over and above the effects of individual characteristics on healthcare acess for low-income children and adults residing in large metropolitan statistical areas (MSAs). Further, we rank MSAs’ performance in promoting healthcare access for their low-income populations. The individual-level data come from the 1995 and 1996 National Health Interview Survey (NHIS). The community-level variables are derived from multiple public-use data sources. The out-come variable is whether low-income individuals received a physician visit in the past twelve months. The proportion receiving a visit by MSA varied from 63% to 99% for children and from 62% to 83% for adults. Access was better for individuals with health insurance and a regular source of care and for those living in communities with more federally-funded health centers. Children residing in MSA

http://healthpolicy.ucla.edu/publications/Documents/PDF/Access%20to%20Medical%20Care%20for%20Low%20Income%20Families%20How%20Do%20Communities%20Make%20a%20Difference.pdf

Access to medical care for low-income persons: how do communities make a difference?

Objective. —To examine the determinants of health insurance coverage for Latinos in the United States and how different targeted strategies for health care reform differentially affect the country's major ethnic groups, focusing on the implications for the Latino population. Design. —Data from the 1980 and 1990 Current Population Surveys were used to compare the insurance status of nonelderly ( Main Outcome Measures. —Percentage uninsured, percentage insured by Medicaid, and attributable fraction for covariates. Results. —Latinos have the worst health insurance coverage of any ethnic group in the country. Approximately 39% of Latinos are uninsured compared with 13.8% for the Anglo and 24% for the black population. Providing coverage to all the poor could reduce the uninsured rate for Anglos by about 23%, whereas the reduction among Latinos could be about 37% and among blacks about 42%. Similar reductions could be achieved by covering all workers and their minor dependents. Regardless of the approach to reform, however, Latinos would remain with high absolute rates of uninsured. Conclusions. —Differences in Medicaid eligibility, labor force characteristics, and family composition between Latinos and other ethnic groups suggest that policy initiatives may affect Latinos differently. Targeted strategies, such as employer mandates, "pay-or-play" programs, or Medicaid expansions, can improve coverage, but many Latinos could still remain uninsured. (JAMA. 1993;269:889-894)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=403562&pdfFileName=jama_269_7_031.pdf

Insuring Latinos Against the Costs of Illness

US metropolitan areas are characterized by pronounced disparities in rates of health insurance coverage and access to care While it has been well documented that people with lower incomes run a greater risk of being uninsured than those with higher incomes, this study also finds a strong relationship between a city’s rate of employer-sponsored health coverage and its overall rates of health coverage and access to care We examined health insurance coverage and access to health care among moderate- and low-income, nonelderly residents of the nation’s largest metropolitan areas

/pdf/disparities-in-health-insurance-and-access-to-care-for-1yf8njcjvi.pdf

Disparities in Health Insurance and Access to Care for Residents Across U.S. Cities

Objective To examine the effects of health insurance coverage and other factors on access to prescription medicines for non-elderly women ages 18–64. Methods Based on a nationally representative telephone survey of adult women in the United States, this study uses multiple logistic regression to determine the factors significantly associated with cost barriers among non-elderly women. The sample for the study includes 1,177 women ages 18–64 who use ≥1 prescription drug on a regular basis. Cost barriers are defined as not filling a prescription or skipping or splitting doses owing to cost. A composite variable of income and health insurance was created to examine the role of insurance in mitigating barriers for women of different income levels. Descriptive analyses report the share of subgroups of women who have faced any of these cost barriers, and logistic regression analyses were used to examine the role of health insurance, income, and other factors in predicting financial access to prescribed medications. Key Findings Over half (54%) of non-elderly women reported that they were taking a prescription medicine on a regular basis, and nearly one third (32%) of these women reported experiencing ≥1 affordability barrier in the prior year and had to either forgo or delay a prescription and/or reduce dosages to make medicines last longer because of costs. Uninsured women had the highest odds of facing a cost barrier, regardless of income level. Low-income, uninsured women were nearly 7 times as likely to face a cost barrier to prescription drugs, compared with higher income women with insurance. Even uninsured women with incomes ≥200% of the federal poverty level had 5 times the odds of facing a prescription medicine cost barrier, and low-income, insured women experienced 2 times the odds of a prescription medicine cost barrier, compared with their higher income, insured counterparts. Conclusion Lack of health insurance coverage was significantly associated with experiencing cost barriers, regardless of income level, underscoring the critical role that insurance coverage plays in protecting women from out-of-pocket costs and for accessing prescription medicines. Limiting out-of-pocket spending is also important for low-income women who have insurance, because even minimal costs can act as barriers for this group.

Role of health insurance coverage in women's access to prescription medicines.

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