Overview
The Andersen Behavioral Model of Health Services Use was first set out by the sociologist Ronald Andersen in a 1968 report from the University of Chicago's Center for Health Administration Studies. It was originally meant to explain families' use of care but was later recast at the individual level and became the most widely used framework for analyzing health care utilization in public health and social work. It shows that using services reflects not only illness but also personal characteristics, resources and the health system.
The three factors
- Predisposing factors: characteristics present before illness that shape the propensity to use care, including demographics (age, sex), social structure (education, occupation, ethnicity) and health beliefs (attitudes and knowledge about health and services).
- Enabling factors: resources that make use possible or block it, both personal and family (income, health insurance, a regular source of care) and community (health personnel and facilities, transport).
- Need factors: the most immediate cause of use, divided into perceived need (symptoms and self-rated health) and evaluated need (illness and disability assessed by professionals).
Need usually explains utilization most strongly, while predisposing and enabling factors account for differences in whether and how much care is used.
Development of the model
- Phase 1 (1968): the basic model in which the three factors lead in sequence to use of services.
- Andersen–Newman framework (1973): added outer layers for health system characteristics (policy, resources, organization) and societal determinants (technology, norms), and distinguished types of service use.
- 1995 revision: added the external environment, personal health practices and outcomes (perceived health, evaluated health, consumer satisfaction), with feedback loops from outcomes back to the factors. Andersen argued the model still matters for assessing access to care.
Equity and applications
Andersen treated access as equitable when use is explained mainly by need and demographic factors, and inequitable when enabling factors such as income or insurance, or social-structural factors, play a large role. The model is therefore common in research on health inequalities and in evaluations of health coverage policy.
- Typical studies: outpatient and inpatient use by older adults, intention to use long-term care insurance, utilization by people with chronic illness, unmet need among migrants and people with disabilities.
- Limitations: the many factors mean variable selection differs from study to study, and critics say it underplays social networks, culture and provider influence. For planning behavior change it is often paired with frameworks such as the PRECEDE-PROCEED model.
References
- Andersen, R. (1968). A Behavioral Model of Families' Use of Health Services (Research Series No. 25). Chicago: Center for Health Administration Studies, University of Chicago.
- Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly: Health and Society, 51(1), 95–124.
- 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.