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Editorials |

Improving Access to Specialty Care for Chronic Cough

Kaiser G. Lim, MD, FCCP
Author and Funding Information

Affiliations: Dr. Lim is Consultant, Divisions of Pulmonary and Critical Care Medicine, Mayo Clinic.

Correspondence to: Kaiser G. Lim, MD, FCCP, 200 First St SW, Rochester, MN 55905; e-mail: Lim.kaiser@mayo.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):959-961. doi:10.1378/chest.09-1026
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Access to health care is an abstract concept regarding the degree of fit between the capacity of the health-care system and patient demand.1 The term may refer to entry into the health-care system or as a characterization of factors influencing use or entry.2 Several dimensions to health-care access include availability, accessibility, accommodation, affordability, and acceptability.1 In 2003, access was redefined, incorporating the patient's perspective and additional dimensions of appropriateness and timeliness of service.3 Patient-centered access is the “patient's ability to secure appropriate and preferred medical assistance when and where it is needed.”3 Lack of access and delay in receiving care for nonemergent illness is a constant challenge confronting our health-care systems. Waits, delays, and deferred care in the health-care system are signs of a mismatch between demand and supply. In countries with publicly funded health-care systems, access to procedures and specialty services is hotly debated,4,5 and is a tool to control cost and to ration care.6,7 Patient dissatisfaction, worsening of clinical outcomes, high no-show rates, and staff dissatisfaction are secondary to the inability to provide timely care. The Institute of Medicine8 has identified improving access in primary care and specialty care as a priority.

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