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Journal of Health and Social Behavior.
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RONALD M. ANDERSEN
University at LosAngeles
ofCalifornia
HealthBeliefs
EQUITABLEACCESS DEMOGRAPHIC
CHARACTERISTICS *
USE OF
HEALTH SERVICES
NEED
DEMOGRAPHIC LOW
ENABLING HIGH
NEED (LOW?)
Characteristics
Population Personal
Health Perceived
Health
Practices Status
Environment
External I
Consumer
Satisfaction
increasesrelativeto theamountofhealthcare tion, longitudinaland experimentalstudy
servicesconsumed(Aday 1993; Aday et al. designs,and innovativetypesof statistical
1993). analyses.I certainly
think,however,thatthe
I do feel compelledto show yetone final payoffis therein termsof betterunderstand-
Phase4 emerging model(Figure7). Whatthis ing of healthbehaviorand informing impor-
phase emphasizesis the dynamicand recur- tanthealthpolicy.
sive natureof a healthservices'use model In revisitingthe behavioralmodel, I am
whichincludeshealthstatusoutcomes(Evans convincedthat"it does matter forsociologists
and Stoddart1990; Patricket al. 1988). This to be involved"-not necessarilywith this
model portraysthe multipleinfluenceson particular model,butcertainly withstudiesof
health services' use and, subsequently, on healthservices'use andaccessto care.Health
healthstatus.It also includesfeedbackloops servicesare partof thelargestsectorof our
showing that outcome, in turn, affects economy-one thatis stillgrowing.Theydo
subsequentpredisposingfactors and per- makea difference forbetter,
or sometimes for
ceived need for servicesas well as health worse, for our societyand its people. The
behavior. currentdebate,recentdefeat,and continuing
Implementation of this model requires directionsof so-called"healthcare reform"
morecreativeand challenging conceptualiza- reinforce
mybeliefthatstudiesof equityand
FIGURE 6. AdditionalMeasures of Access
IMPROVED
and effective
efficient access examinedfrom Loevy, and BarbaraKremer.1985. Hospital-
a comprehensive and systemicperspective PhysicianSponsoredPrimaryCare: Marketing
will be relevant and importantfor the and Impact.AnnArbor,MI: HealthAdministra-
indefinitefuture(Mechanic 1993). Sociolo- tionPress.
gists, particularlyour youngercolleagues Aday, Lu Ann, Charles E. Begley, David R.
withnewperspectives and strongdisciplinary Lairson,and Carl H. Slater. 1993. Evaluating
the Medical Care System:Effectiveness, Effi-
and methodologicaltraining,have special ciency,and Equity. Ann Arbor,MI: Health
contributionsto maketo thesestudies(Pesco- AdministrationPress.
solido and Kronenfeld,forthcoming).In Andersen,RonaldM. 1968. BehavioralModel of
conclusion,I would like to paraphrasethe Families' Use of Health Services. Research
"old soldier's quote" of General Douglas SeriesNo. 25. Chicago, IL: CenterforHealth
MacArthur: "Old medicalsociologistsnever AdministrationStudies,Universityof Chicago.
die, theyjust stopbeingcitedin theJournal Andersen,Ronald M. and Odin W. Anderson.
ofHealthand Social Behavior." 1967. A Decade of Health Services.Chicago,
IL: Universityof ChicagoPress.
Andersen,RonaldM. andJohnF. Newman.1973.
REFERENCES "Societaland IndividualDeterminants
of Medi-
cal Care Utilizationin the United States."
Aday,Lu Ann. 1993. "Access to Whatand Why?
Toward a New Generationof Access Indica- Milbank Memorial Fund QuarterlyJournal
tors."ProceedingsofthePublicHealthConfer- 51:95-124.
ence on Records and Statistics.Washington, Andersen,Ronald M., Pamela Davidson, and
D.C.: U.S. Government Office.
Printing PatriciaGanz. 1994. "SymbioticRelationships
Aday,Lu AnnandRonaldM. Andersen.1974. "A of Qualityof Life, HealthServicesResearch,
Framework fortheStudyof Access to Medical and OtherHealth Research." Qualityof Life
Care." HealthServicesResearch9:208-20. Research3:365-71.
Aday,Lu AnnandWilliamC. Awe. Forthcoming. Andersen, Ronald M., Marvin Marcus, and
"HealthSourcesUtilizationModels." In Hand- MichaelMashigian.Forthcoming. "A Compar-
book of Health Behavior Research Vol. 1. ative Systems Perspectiveon Oral Health
Determinants ofHealthBehavior:Personaland Promotionand Disease Prevention."In Oral
Social, editedby D.S. Gochman.New York: Health Promotion:Socio-Dental Sciences in
Plenum. Action,editedby L.K. Cohen and H.C. Gift.
Aday, Lu Ann, Ronald M. Andersen, and Copenhagen,Denmark:Munsksgaard.
Gretchen V. Fleming.1980. HealthCare in the Andersen,Ronald M., Bjorn Smedby,and Odin
U.S.: Equitablefor Whom?BeverlyHills, CA: W. Anderson. 1970. Medical Care Use in
Sage. Swedenand the UnitedStates-A Comparative
Aday, Lu Ann, Ronald M. Andersen,Sarah Analysisof Systemsand Behavior. Research