The settings investigated were departments of internal medicine (IM), orthopaedics and surgery in acute care hospitals in Sweden. The objective was to identify exogenous and endogenous determinants of accessibility of health care. Both qualitative and quantitative analysis of utilisation was performed on national and regional level of data aggregation. The study proposes that accessibility to acute health services is influenced by exogenous factors, partly outside the control of health care professionals, such as season, physical proximity and overall supply. Organisational properties such as availability of inpatient beds, hospital and physician specialisation and the degree of system integration between provides of emergency care have effects on the quality of care. The novel finding is the strong association between acute readmissions and remaining inpatient utilisation indicating effects of bed supply on global use within IM. These conclusions follow:
§ structural changes on system level work as a method of prioritisation between patient groups by changes in criteria of accessibility;
§ the natural and organisational environments determine waiting times in EDs in hospitals by fluctuations of demand;
§ geographical accessibility coincides with the supply in terms of over- or underutilisation mirrored in the outcome of medical care;
§ effective access is determined by the divide of resources between inpatient and outpatient care and the total supply of inpatient care;
§ increasing demands on inpatient care in IM may be derived from deficiencies in the care of chronically ill, elderly patients;
§ transition of information and communication among care givers and patients varies in efficiency depending on vehicles for coordination and system integration;
§ the level of training of the admitting physician has effects on effective accessibility to inpatient care.
There are conflicts between accessibility, efficiency and appropriateness of settings calling for attention to capacity to benefit in addition to needs as priority criteria.