title: A framework for evaluating safety-net and other community-level factors on access for low-income populations.
abstract: The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.
authors.affiliation: Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA. Davidson@ucla.edu
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Davidson
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Andersen
authors.forename: Roberta
authors.initials: R
authors.lastname: Wyn
authors.forename: E Richard
authors.initials: ER
authors.lastname: Brown
mesh_terms: D000553:Ambulatory Care; D019058:Community Networks; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D017057:Medically Uninsured; D010342:Patient Acceptance of Health Care; D011203:Poverty; D015203:Reproducibility of Results; D013597:Systems Analysis; D014481:United States