Understanding the Behavioral Model of Health Services
This article, “Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?” by Ronald M. Andersen, was published in the Journal of Health and Social Behavior in March 1995. The author’s primary intent is to review the development of the Behavioral Model of Health Services Use and assess its ongoing relevance, a model that has significantly influenced his career.
The Behavioral Model was initially developed in the late 1960s with several key objectives:
To understand why families use health services.
To define and measure equitable access to health care.
To assist in developing policies aimed at promoting equitable access.
Originally, the model focused on the family as the unit of analysis, acknowledging that an individual’s medical care is influenced by family characteristics. However, subsequent work shifted the unit of analysis to the individual for efficiency, attaching important family characteristics to the individual. The initial design of the model specifically aimed to explain the use of formal personal health services, rather than focusing on interactions during care or health outcomes.
The Initial Behavioral Model (1960s) As depicted in Figure 1 of the article, the initial model proposed that people’s use of health services is a function of three main components:
Predisposing Characteristics: These are factors that exist prior to the onset of illness and suggest a propensity to use services. They include demographic factors (such as age and gender, representing biological imperatives for health service needs), social structure (including education, occupation, and ethnicity, which determine a person’s status and ability to cope), and health beliefs (attitudes, values, and knowledge about health and services). The author notes that social networks, social interactions, and culture fit within the social structure component, and suggests genetic and psychological characteristics as potential additions to predisposing factors.
Enabling Resources: These factors make health services available and accessible. They encompass both community-level resources (e.g., availability of health personnel and facilities) and personal/family resources (e.g., income, health insurance, a regular source of care, and travel/waiting times). The author acknowledges criticisms regarding the lack of attention to organizational factors and the need for more precise measures of health insurance benefits, agreeing that these can be incorporated as additional enabling factors. Social relationships can also serve as enabling resources, either facilitating or impeding health services use.
Need for Care: This is considered the most immediate reason for health services use. It can be categorized as perceived need (how people view their own health and symptoms) and evaluated need (professional judgment about health status and medical care needs). The author clarifies that perceived need is largely a social phenomenon explained by social structure and health beliefs, while evaluated need, though having a social component, also reflects a biological imperative for help-seeking.
Reference: Andersen, R. M. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does it Matter? Journal of Health and Social Behavior, 36(1), 1–10. https://www.jstor.org/stable/2137284