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My intent is to review the development of a model of health services' use that has dominated my career. Others as well have applied, criticized, and revised it (Aday and Awe, forthcoming). Pescosolido and Kronenfeld (forthcoming) argue that the best of it has been coopted and more effectively applied by health economists and psychologists, while medical sociologists have increasingly ignored it and the kinds of health services' use studies for which it was developed.
The model was initially developed in the late 1960s to assist the understanding of why families use health services; to define and measure equitable access to health care; to assist in developing policies to promote equitable access; and, not incidentally, to pass my dissertation committee at Purdue (Andersen 1968). It was not the first or only model at the time, but it did attempt to integrate a number of ideas about the "how's" and "why's" of health services' use. It was intended to assist in the analysis of national survey data collected by the Center for Health Administration Studies and the National Opinion Research Center at the University of Chicago where I worked with Odin Anderson (Andersen and Anderson 1967).
The model of health services' use originally focused on the family as the unit of analysis, because the medical care an individual receives is most certainly a function of the demographic social and economic characteristics of the family as a unit. However, in subsequent work I shifted to the individual as the unit; of analysis because of the difficulty of developing measures at the family level that take into account the potential heterogeneity of family members; e.g., a summary measure of "family health status." I think it is generally more efficient to attach important family characteristics to the individual as the unit for analysis. Finally, I want to stress that the model was initially designed to explain the use of formal personal health services rather than to focus on the important interactions that take place as people receive care, or on health outcomes.
The initial behavioral model--the model of the 1960s--is depicted in Figure 1. (Figure 1 omitted) It suggests that people's use of health services is a function of their predisposition to use services, factors which enable or impede use,...