Factors affecting patients’ ability to access healthcare: overview of systematic reviews

Added June 7, 2022

Citation: Dawkins B, Renwick C, Ensor T, et al. What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health. 2021;26(10):1177-88.

Language: Abstract and full text available in EN.

Free to view: Yes.

Funding sources: National Institute for Health Research.

What is this? In many countries, patient’s face barriers to equitable access to health care. Evidence on these barriers might help policy makers to overcome them and ensure universal access to health care.

In this overview, the authors searched for systematic reviews of factors that contribute to healthcare accessibility and inaccessibility in low- and middle-income countries (LMICs) compared to high income countries (HICs). They restricted their searches to systematic reviews published in English after 1 January 2014. They included 58 reviews, 23 of which presented findings from LMICs and 35 presented findings from HIC.

What was found: In LMICs, the most common reported barrier to accessing healthcare services was gender, which was often associated with perceptions of women in these communities and their expected gender roles. Lack of decision-making power also disproportionately affected women in LMICS.

In LMICs, a low income or lack of access to money was a common barrier to accessing healthcare services. Financial barriers were more common in LMICs than in HICs.

In LMICs, a common delay to accessing health care was the unavailability of services, while, in HICs, a common delay was waiting lists.

In HICs, language and communication, and fear of deportation and incarceration were common barriers to accessing health care, particularly for migrant populations.

In both LMICs and HICs, lack of education, ethnicity and distance to services were commonly reported barriers to accessing health care.

Implications: The authors concluded that as countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. They noted that methods used in HICs may not be appropriate in LMICs due to stark differences between these settings.

Other considerations: The authors of the review discussed their findings in the context of place of residence, race, ethnicity, culture, language, gender, sex, religion, education, socioeconomic status, social capital and age.


This summary was prepared by Yasmeen Saeed and finalized by Mike Clarke.

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