Systemic and Dynamic Analysis of Access to Health Care: The Example of Hematological Cancer in France

Objective: Access to health care aims to improve people’s health and reduce inequalities. This is a fundamental health policy concern. Over the past 40 years, research has identified several dimensions of access to health care but has often overlooked their interconnections. Based on a mixed geographical and relational method, our article aims to propose a systemic and dynamic analysis of the main dimensions of access to care. Methods: The population studied in this work consists of all 364 hematological cancer patients. In the first step, we map the movements of these patients in order to categorize them according to their ease of access to care. In the second step, we conduct semistructured interviews to identify nonspatial dimensions of access to care. Results: Our theoretical results focus on identifying the main links and articulations between dimensions of access to care. They confirm the importance of geographical accessibility in access to care, but, in a more original way, they show the central role of acceptability (confidence in healthcare professionals), itself determined by awareness. Conclusion: This study suggests that policies to improve access to care should be accompanied by the development of patient awareness and acceptability. In practice, this can be achieved by combining tools such as cooperation between hospitals and healthcare professionals, professional networks, telemedicine, and local hospital accreditation.