Access to Rehabilitation

Welcome to Understanding Rehabilitation Content Development Project. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!! If you would like to get involved in this project and earn accreditation for your contributions, please get in touch!

Original Editors - Add your name/s here if you are the original editor/s of this page.  User Name

Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Vidya Acharya, Kim Jackson, Rucha Gadgil, Olajumoke Ogunleye, Tony Lowe and Oyemi Sillo      

Introduction

While the principle that everyone has the right to timely access to affordable, preventive and curative health care is recognised in many countries globally, there remains large gaps in access to health care which have been further exacerbated in the wake of the COVID-19 pandemic. Access to healthcare is a complex concept. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services, but the services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The extent to which a population 'gains access' depends on a wide range of factors including financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply.

If we consider these aspects, then access to health care means having timely use of personal health services to achieve the best possible health outcomes and comprises of the following four key components;

Coverage

Facilitates entry into the health care system. Uninsured people or those with lower income are less likely to receive medical care and more likely to have poor health status.Disparities in health have been shown to have a strong socio-economic component. Differences in health outcomes by the level of income may be due to a range of factors, for example: behavioural aspects, exposure to risk factors, stress, quality of housing, employment. Higher prevalence of ill health in groups with lower socio-economic status may also to some extent and in some cases be explained by problems in access to healthcare and inadequate use of healthcare services.

Services

Having a usual source of care and / or usual health care provider.has been shown to lead to better health outcomes, fewer disparities in healthcare access, and lower costs. While people with a usual place of care and a usual provider are more likely to receive preventive services and recommended screenings than people with no usual source of care.

Timeliness

Ability to provide health care when the need is recognised is focused on the health system’s capacity to provide care quickly after a need is recognised. Timely delivery of appropriate care can help reduce mortality and morbidity for chronic conditions, such as kidney disease.

Workforce

A Health Service with capable, qualified, culturally competent providers. Ensuring well-coordinated, high-quality health care requires the establishment of a supportive health system infrastructure. Key elements include: Well-distributed capable and qualified workforce. Organizational capacity to support culturally competent services and ongoing improvement efforts. Health care safety net for hospital admissions of vulnerable populations.

Right To Health

The right to health contains four elements:

Availability

Functioning public health and health care facilities, goods and services, as well as programmes in sufficient quantity.

Accessibility

Health facilities, goods and services accessible to everyone, within the jurisdiction of the State party. Accessibility has four overlapping dimensions: non-discrimination; physical accessibility; economical accessibility (affordability); and information accessibility.

Acceptability

All health facilities, goods and services must be respectful of medical ethics and culturally appropriate as well as sensitive to gender and life-cycle requirements.

Quality

Health facilities, goods and services must be scientifically and medically appropriate and of good quality.

Barriers to Health

There are wide range of barriers that can prevent individuals from receiving high quality health care.  These include:

Personal

The first step in the process of accessing health services generally revolve around an individuals recognition of their need and their decision to seek access to health care. The likelihood of an individual accessing health care is influenced by a balance between the perceptions of their needs and their attitudes, beliefs and more importantly their previous experiences with health services and are generally subject to social and cultural infuences as well as environmental constraints.

Financial

Access to and utilisation of health care services are often limited as a result of financial barriers. Even in systems where access is essentially free at the initial point of use, there are often some services that still require payment or top up fee, or alternatively costs as a result of time lost from work or in travelling to and from a clinic or costs of child care in order to attend appointments. The impact of user charges and other associated costs of accessing care affect different socio-economic groups in different ways, for some groups their access is not affected, while our others these costs may represent a significant deterrent. As such equal costs for health care services do not necessarily give equal access and financial incentives can influence the availability of services and the types of service available.

Organisational

Long waiting lists and waiting times may sometimes be indicative of organisational barriers to access which may result from inefficient use of existing capacity or a failure to design services around the needs of patients. Systematic variations in referral practices also act as barriers to accessing care, especially referral from primary to secondary care. Redesign of the way clinical services are delivered, such as the replacement of waiting lists with booking systems, might do much to reduce organisational barriers to access. Policies or standards that systematically disadvantage those in need of rehabilitation services e.g.  at a health care facility people may need to stand in a long line before receiving services, which can be a barrier for individuals who have balance problems or a hospital administrator who does not allocate needed resources for rehabilitation services. )

Governmental

Laws or policies that do not consider rehabilitation needs of the population e.g. rehabilitation services and assistive products not covered under a nation’s Health Care Plan

Service Delivery

Negative attitudes, presumptions, prejudices, or misconceptions e.g. low prioritisation of coordination of care by rehabilitation professionals leading to a lack of appropriate referrals for needed continuum of care.  

Environmental

Barriers in the built or natural environment e.g. no ramp to enter the health facility or no public transportation that accommodates wheelchairs or those with mobility impairments.

Informational

Not offering the same health information to all people e.g. lack of data and research on which treatment interventions for specific impairments are most effective.

Facilitators to Access

• reforming policies, laws, and delivery systems, including development or revision of national rehabilitation plans;
• developing funding mechanisms to address barriers related to financing of rehabilitation;
• increasing human resources for rehabilitation, including training and retention of rehabilitation personnel;
• expanding and decentralising service delivery;
• increasing the use and affordability of technology and assistive devices;
• expanding research programmes, including improving information and access to good practice guidelines.