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Abstract: The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive. The three types of barriers are reciprocally reinforcing and affect health care access individually or in concert. These barriers are associated with screening, late presentation to care, and lack of treatment, which in turn result in poor health outcomes and health disparities. By targeting those barriers that are measurable and modifiable the model facilitates root-cause analysis and intervention design.
Key words: Health disparities, cultural competence, racial/ethnic disparities, health care access barriers, cause of disparities, access barriers model.
The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented.1,2,3 Increasingly, multifactorial models are being presented to explain the causes for such disparities.4,5,6,7 Health care access barriers play an important role in understanding the causes of disparities.8 This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those health care access barriers frequently faced by populations that exhibit adverse health disparities. The model is equally applicable across all racial and ethnic groups and specifically targets those access barriers which are modifiable in order to support the design of community-based interventions that may lead to reduced disparities.
The HCAB model has been used to design community-based health interventions to reduce the complications of diabetes mellitus in a high prevalence community and to improve cancer screening among Latinas.9,10 In our community health work, we used the HCAB model to facilitate the realignment of prevention and health care services provided by a major academic medical center, NewYork-Presbyterian Hospital, to a large community of Latino immigrants in Washington Heights Inwood.11 A community health needs assessment, linked with an analysis of financial, structural and cognitive barriers guided the development of Patient Centered Medical...