Uma revisão sobre os conceitos de acesso e utilização de serviços de saúde

Abstract

The purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. Access is a complex concept (often used inaccurately) which changes over time and according to the context. Health services utilization is at the core of health systems functioning. Despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. Health care services utilization can be applied as a measure of access, but use of services depends on other factors. Individual and contextual factors influence the use of services. The article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. Access is valued in relation to its impact on health and depends on the effectiveness of care delivered. As an outcome measure, access becomes multidimensional and difficult to operationalize. Finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health.

Accesibilidad a los servicios públicos de salud: la visión de los usuarios de la Estrategia Salud de la Familia

“…El PMAQ propone un modelo de evaluación de desempeño de los sistemas de salud, en los tres niveles del gobierno, que pretende medir los posibles efectos de la política de salud con miras a subsidiar la toma de decisión, garantizar la transparencia de los procesos de gestión del SUS y dar visibilidad a los resultados alcanzados, además de fortalecer el control social y el enfoque del sistema de salud en los usuarios (3) .…”

Qualidade de vida em pacientes com retinopatia diabética proliferativa

“…Sobre a acessibilidade pode-se dizer que esta significa o grau de facilidade com que as pessoas obtêm os cuidados de saúde, e representa o centro do funcionamento dos serviços de saúde, no que concerne ao atendimento direto a consultas médicas e hospitalização, como também ao indireto, por meio da realização de exames preventivos e diagnósticos. A acessibilidade ultrapassa as condições e distribuições geográficas de acesso ao paciente, porque também compreende questões como o acolhimento por parte dos profissionais, disponibilidade dos serviços às necessidades dos pacientes, entre outras questões que visam à promoção da saúde dos que procuram esses serviços (15) .…”

Acessibilidade à atenção básica a famílias negras em bairro popular de Salvador, Brasil

“…8 Different uses and defi nitions are identifi ed in the operationalization of these concepts. 27 Access covers the availability of health services from the point of view of what is provided. Accessibility deals with the practicalities of being able to use the services on offer.…”

“…Travassos & Martins 27 consider that "accessibility (…) is more than the mere availability of resources at a specifi c time and place. It refers to characteristics of the health services and resources which facilitate or limit their use by their potential users".…”

“…27 Accessibility can be measured by the ration between the resistance represented by these barriers and the users' efforts to overcome them (health care utilisation). 9 The guarantee of universal access to the SUS depends upon identifying barriers related to the characteristics and needs of the population.…”