The Overview of the Model
Initially developed in the late 1960s by Ronald M. Andersen (a professor of health services) as a theoretical model, the Andersen’s Behavioral Model of Health Care Utilization has been used to explore individual and contextual characteristics that may facilitate or impede health services utilization in a much broader orientation than most other models (Bradley, Curry, & Devers, 2007). In most general terms, the model aims to identify the factors that may trigger the necessity of using health assistance.
The model relies on the assumption that the use of a wide range of health care services (including both in-patient and home care) is conditioned by the major factors:
- predisposition aspects (e.g. gender, ethnicity, age, beliefs about treatment, health habits, etc.);
- enabling factors (access to health care, the general state of health in the community, the attitude of family members to treatment and their support, etc.);
- needs (encompassing both real needs for medical assistance and perceived ones) (Babitsch, Gohl, & Lengerke, 2012).
This framework was further developed and several alterations were introduced. In its most recent form, the model covers the whole process of treatment starting from the patient’s previous experience in health care and ending with long-term outcomes as the ultimate goal of any medical intervention. A feedback loop has been integrated into the latest version of the model. It deals with the ways the experience may affect the patient’s previous needs as well as his/her views of health care. It allows identifying the direction of the changes produced in the patient’s characteristics and his/her immediate environment. The Anderson’s Behavioral Model will be subjected to other improvements, which are going to include genetic factors that can influence treatment methods and assist in predicting its outcomes (Andersen, Rice, & Kominski, 2011).
Use of the Andersen Behavioral Model for Health Care Research
The Behavioral Model is popular among health care researchers and has often been used in studies conducted in the US and the UK. Many authors who attempt to do systematic reviews of different aspects of medical treatment use the model to facilitate the process of structuring their findings. However, in other European countries, such as Germany, the model was largely neglected up to the present day when medical science has started to show an increased awareness of its potential (Babitsch et al., 2012).
The major feature of the model that attracts researchers is its universality: it can be used in studies belonging to different areas of health care and for analyzing a whole range of diseases (Andersen, 2008). The most widely spread version of it is the one established in 1995. It is worth mentioning that scientists choose different variables for their research (they may include education, marital status, and ethnicity as predisposing factors and financial position and health insurance as enabling ones). However, in terms of needs, most studies use only two factors: the evaluated state of health and the perceived one (Fasoli, Glickman, & Eisen, 2010).
Thus, despite the frequent use of the model in health research, there exist significant variations in the method of selection and categorization of variables.
Summary of the Theoretical Model
As has already been mentioned, according to the model, and access to health care features three characteristics. Thus, the theoretical foundation of the model can be briefly summarized as follows (Frølich, Talavera, Broadhead, & Dudley, 2007):
- predisposing factors:
- socio-cultural aspects that exist before the disease appears;
- social structure (education, job, social status, etc.);
- health beliefs (attitudes to treatment);
- demographic aspects (gender, age, etc.);
- enabling factors:
- family participation (the quality of relationships in a family, care, support, etc.);
- community settings (facilities available in the community, the general state of health care, waiting time, etc.);
- genetic characteristics (as a potential addition);
- need factors:
- evaluated needs (professional assessment of the health status);
- perceived needs (the patient’s perception of his/her health).
Analysis and Limitations of the Andersen Behavioural Model
The Andersen Behavioral Model is a multilevel framework that encompasses both personal and environmental determinants of health care. Moreover, it manages to structure contextual characteristics affecting the quality of health care in the same manner as the one used for the categorization of individual factors. The wide range of factors included in the model allows using it in the investigation of a considerable number of various diseases (Andersen et. al., 2011).
However, the model has often been criticized for neglecting culture and the ways of interaction accepted in it. Another limitation identified by scholars it the focus on need factors at the expense of social aspects. This is a debatable issue as the perceived needs usually include health beliefs inherent in the social context. The community often predetermines the ways a person understands health care and anticipates the outcomes of the treatment. The most widely accepted criticism concerns the view of health care utilization as a factor that could be either present or absent, which is quite detached from reality as it excludes a whole number of health-seeking behaviors (Bradley et al., 2007).
References
Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical Care, 46(7), 647-653.
Andersen, R. M., Rice, T. H., & Kominski, G. F. (2011). Changing the US health care system: key issues in health services policy and management. Hoboken, NJ: John Wiley & Sons.
Babitsch, B., Gohl, D., & Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9(1), 23-36.
Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758-1772.
Fasoli, D. R., Glickman, M. E., & Eisen, S. V. (2010). Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services. Medical Care, 48(4), 288-295.
Frølich, A., Talavera, J. A., Broadhead, P., & Dudley, R. A. (2007). A behavioral model of clinician responses to incentives to improve quality. Health Policy, 80(1), 179-193.