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When the Government introduced user fees in 1993, considerable concern was expressed about the adverse effects on utilisation and access.
User partners (i.e., senior managers responsible for the services included in the study) contributed to the final selection of study sites by identifying sub-districts classified as priority areas for utilisation and access evaluation.
Utilisation or accessibility of care refers to the volume of service usage and service given, the site of utilisation and access and the type of services used and having access [ 7].
This questionnaire covers the following domains: demographics, health status and quality of life, knowledge and risk factors (cardiovascular and diabetes), health utilisation and access to healthcare, and perceived concern and understanding of risk.
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We measured access comprehensively in its two dimensions: realised access (utilisation) and non-access (unmet medical needs).
The main strength of our study is the comprehensive analysis of equity in health care access in its two dimensions: horizontal and vertical equity in realised access (utilisation) and non-access (unmet medical needs).
An equitable health service implies that individuals' utilisation of and access to service depends on their health state alone, and not upon their socio-economic status [ 51].
We did not have information about the ethnicity of women's partners, which beside all other factors may also affect women's utilisation of and access to maternity care.
This paper examines changing patterns in the utilisation and geographic access to health services in Great Britain using National Travel Survey data (1985-2012).
A systematic review of the determinants of emergency department visits by older patients, found that perceived and actual poor health status, previous hospital/emergency department utilisation, and lack of access to primary health care services were the main risk factors for presentation to hospital [ 13].
Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services.
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