This paper summarized much of my thinking and its evolution over the previous 30 years concerning people's access to medical care. It was published in a fairly salient journal concerning social science and health. It deals with a topic of continuing interest in health services research, medical sociology, and for policy makers concerned with the organization and delivery of medical care.

“I was struck by the differences in the kinds and amounts of medical care that people in the U.S. used, and was concerned about why some had good access to medical care and others did not.”

I was a doctoral student in a medical sociology training program under the direction of Dr. Robert Eichhorn at Purdue University in 1963. The Center for Health Administration Studies and NORC at the University of Chicago, with Dr. Odin Anderson as the principal investigator, had a grant from what is now the Agency for Healthcare Research and Quality to do a national survey study of medical care use and expenditures. I was hired as the study director for the project with the agreement that as I directed the study I would also be supported to use data from the study for my dissertation. I was struck by the differences in the kinds and amounts of medical care that people in the U.S. used, and was concerned about why some had good access to medical care and others did not. To try to better understand these variations, for my dissertation I developed a behavioral model of health services use which suggested that access to care was determined by different characteristics of people including predisposing factors (e.g., age, gender, education, ethnicity, health beliefs), enabling factors (e.g., having a regular source of medical care and health insurance) and need (e.g., their perceptions of their health and physician's judgments about their need for care). I have continued to work on this problem for my entire career.