The Relationship Between Access to Health Services and Service Quality in Realizing a Just and Sustainable Health System
Keywords:
Healthcare Access, Service Quality, Equitable Health System, Sustainable Health SystemAbstract
Access to healthcare services is an important determinant in improving the quality of healthcare services, particularly in rural areas that still face geographical and digital limitations. Inequality in access has the potential to hinder the realization of an equitable and sustainable healthcare system. This study aims to analyze the relationship between access to healthcare services and the quality of healthcare services. The research employed a descriptive analytic correlational design with a cross-sectional approach. The sample consisted of 150 community respondents in rural areas of Southeast Aceh Regency selected through purposive sampling. Data were collected using a structured questionnaire measuring dimensions of access (availability, affordability, acceptability, and digital access) as well as the quality of healthcare services. Data analysis was conducted bivariately using statistical tests appropriate to the level of data measurement. The results showed that most respondents perceived access to healthcare services as still inadequate, particularly in terms of geographical affordability and digital access. The quality of healthcare services was categorized as fairly good, although weaknesses remained in infrastructure and facilities. Bivariate analysis indicated a significant relationship between access to healthcare services and the quality of healthcare services (ρ-value < 0.05). Therefore, it is expected that efforts will be made to improve access to healthcare services through strengthening infrastructure, equitable distribution of healthcare personnel, and optimization of digital-based services to support the realization of a fair and sustainable healthcare system.
References
Badr, J., Motulsky, A., & Denis, J. L. (2024). Digital Health Technologies and Inequalities: A Scoping Review of Potential Impacts and Policy Recommendations. Health Policy, 146(June), 1–9. https://doi.org/10.1016/j.healthpol.2024.105122
Bychkovska, O., Strøm, V., Tederko, P., Engkasan, J. P., Juocevičius, A., Battistella, L. R., Arora, M., Egen, C., & Gemperli, A. (2023). Health System’s Role in Facilitating Health Service Access among Persons with Spinal Cord Injury across 22 Countries. International Journal of Environmental Research and Public Health, 20(11), 1–13. https://doi.org/10.3390/ijerph20116056
Bychkovska, O., Tederko, P., Strøm, V., Juocevicius, A., & Gemperli, A. (2024). Does stronger primary care improve access to health services for persons with spinal cord injury? Evidence from eleven European countries. Journal of Spinal Cord Medicine, 47(5), 701–711. https://doi.org/10.1080/10790268.2023.2188390
Cuadros, D. F., Moreno, C. M., Miller, F. D., Omori, R., & MacKinnon, N. J. (2023). Assessing Access to Digital Services in Health Care–Underserved Communities in the United States: A Cross-Sectional Study. Mayo Clinic Proceedings: Digital Health, 1(3), 217–225. https://doi.org/10.1016/j.mcpdig.2023.04.004
da Luz Mendonça, M., de Fátima Carvalho Alves, M., Soares, J., Santos, S., Silva, M. N., Lopes, E. D., Martins, J. J., Ramos, J., & Ferreira, P. L. (2025). User Satisfaction with Health Services and Healthcare Delivery in Cape Verde. BMC Health Services Research, 25(1), 228. https://doi.org/10.1186/s12913-025-12375-8
Debnath, T., Barman, B., Barman, K., & Roy, R. (2023). Accessibility and Availability of Reproductive Health Care Services at Primary Health Centre Level and Association with Health Outcome in Aspirational Districts of India. Clinical Epidemiology and Global Health, 23(June), 101385. https://doi.org/10.1016/j.cegh.2023.101385
Golestani, R., Farahani, F. K., & Peters, P. (2025). Exploring Barriers to Accessing Health Care Services by Young Women in Rural Settings: a Qualitative Study in Australia, Canada, and Sweden. BMC Public Health, 25(1), 213. https://doi.org/10.1186/s12889-025-21387-2
Hannawa, A. F., Wu, A. W., Kolyada, A., Potemkina, A., & Donaldson, L. J. (2022). The Aspects of Healthcare Quality that are Important to Health Professionals and Patients: A Qualitative Study. Patient Education and Counseling, 105(6), 1561–1570. https://doi.org/10.1016/j.pec.2021.10.016
Härkönen, H., Lakoma, S., Verho, A., Torkki, P., Leskelä, R. L., Pennanen, P., Laukka, E., & Jansson, M. (2024). Impact of Digital Services on Healthcare and Social Welfare: An Umbrella Review. International Journal of Nursing Studies, 152(April), 1–18. https://doi.org/10.1016/j.ijnurstu.2024.104692
Hussain, A., Umair, M., Khan, S., Alonazi, W. B., Almutairi, S. S., & Malik, A. (2024). Exploring Sustainable healthcare: Innovations in Health economics, Social Policy, and Management. Heliyon, 10(13), 1–15. https://doi.org/10.1016/j.heliyon.2024.e33186
Karume, A. K., Nyongesa, K., Okutoyi, L., & Kinuthia, J. (2025). Patient’s Expectations and Perceptions on Quality of Care; An Evaluation Using SERVQUAL Gap in Kenya. PLoS ONE, 20(3 March), 1–16. https://doi.org/10.1371/journal.pone.0315910
McBride, K., & Moucheraud, C. (2022). Rural–Urban Differences: Using Finer Geographic Classifications to Reevaluate Distance and Choice of Health Services in Malawi. Health Systems and Reform, 8(1), 1–9. https://doi.org/10.1080/23288604.2022.2051229
Msacky, R. F. (2024). Quality of Health Service in the Local Government Authorities in Tanzania: a Perspective of the Healthcare Seekers from Dodoma City and Bahi District Councils. BMC Health Services Research, 24(1), 1–11. https://doi.org/10.1186/s12913-023-10381-2
Muhumuza Kananura, R. (2024). Unmasking the Complexities of Healthcare Access in Low-Resource Settings: a Health Systems Approach to Obstetric and Under-5 Healthcare in Rural Settings of Eastern Uganda. Global Health Action, 17(1), 1–13. https://doi.org/10.1080/16549716.2024.2397163
Mustafa, A., & Shekhar, C. (2021). Is quality and Availability of Facilities at Primary Health Centers ( PHCs ) Associated with Healthcare-Seeking from PHCs in Rural India : An Exploratory Cross-Sectional Analysis. Clinical Epidemiology and Global Health, 9, 293–298. https://doi.org/10.1016/j.cegh.2020.10.001
Reid, M. J. A., & Katz, I. T. (2025). Redefining Global Health in the 21st Century : Towards a More Equitable Global Health Agenda. Global Public Health, 20(1), 1–5. https://doi.org/10.1080/17441692.2025.2464060
Souza, J. S., Reis, E. A., Godman, B., Campbell, S. M., Meyer, J. C., Sena, L. W. P., & Godói, I. P. D. (2024). Users’ Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges. International Journal of Environmental Research and Public Health, 21(6). https://doi.org/10.3390/ijerph21060721
Yilmaz, S., Ateş, M., & Abay, P. (2025). Adaptation and Psychometric Assessment of the Turkish Version of the Perceived Access to Health Care Questionnaire: Validity and Reliability Analysis. Healthcare (Switzerland), 13(4), 1–22. https://doi.org/10.3390/healthcare13040370
