Relating satisfaction with access to utilization of services.

Underlying the continuing emphasis on access by health services researchers and policymakers is the assumption that patients having poorer access will receive less than appropriate health care, other things being equal. However, recent research results typically have not supported this assumption, and the nature and importance of relationships between access and use still remain unclear. Most published studies have sought to define general relationships that are descriptive of the behavior of all patients in a population facing access problems. The authors use interview data to show that significant relationships between satisfaction with access and use of services can be found if segments of the population, homogeneous in terms of age, sex, or other characteristics, are considered separately. This approach is based on the assumption that dissatisfaction with a particular dimension of access may be salient for some groups of patients but not others, and it is consistent with the view that patients' beliefs and perceptions are important determinants of health behavior.