| Introduction. Although much is known about the importance of individual level factors in explaining access to health care, relatively few studies clarify the role of the health system or factors affecting its functioning, such as the level of managed care. This study examines the relationships between health systems resources, managed care activity, and two indicators of health care access, controlling for other access-relevant factors at the individual and regional level.; Methods. Individual level data from a cross-sectional, population-based survey on health care access, the Ohio Family Health Survey (OFHS), were linked with 1998 data from the Area Resource File. The number of physicians, dentists, medical social workers, and hospital beds per 10000 residents in a zip code were compared between those in which access (having an unmet need) or the potential for access to health care (having no usual source of care) was especially good or poor. The zip code level of managed care activity was defined using the HMO penetration rate. Separate hierarchical analyses determined the independent effects of health system resources and the level of managed care on access, controlling for individual attributes (enabling, predisposing, and need-related) and other environmental characteristics (regional economic status and population density).; Results. Of 15613 individuals responding to this survey, 1248 (8.0%) reported an unmet health care need; 2475 (15.9%) reported no usual source of care. In multi-level models of unmet need, an association with health systems resources was not statistically significant while a significant association with managed care activity remained after controlling for individual factors. We observed a significant association with health system resources in a third analysis modeling access potential.; Conclusions. Access to health care is a multidimensional construct; different indicators of problems with access are useful in understanding the role of health system resources and factors that influence its function on regional patterns of health care access. The better this construct and its determinants are understood, the more effective efforts will be in meeting the challenge of universal access to health care. |
