Methods: Using a case-oriented, cross-country comparison, this study uses the three factors of the Behavioral Model of Utilization (i.e., health system environments, population characteristics and health behaviors/outcomes) to examine health care accessibility for selected vulnerable groups in each of the three countries (i.e., Israel, UK, US).
Results: The health system environments and population characteristics differed dramatically. The health system of the United Kingdom had open access to all; Israel’s health system provided basic healthcare to all citizens, yet citizens could opt for different levels of services. The fee-for-service system in the US resulted in barriers to healthcare access for vulnerable citizens. Regardless of the type of healthcare system and level of access to health care, all three countries experienced threats to health. All health systems showed features indicating their adaptation to the dominant or majority group of the country’s general population. However, all three high income countries' health systems were inadequate at addressing vulnerable population groups (i.e., socioeconomically low income individuals, minorities, immigrants, non-citizens) as demonstrated by unmet need and inadequate health behaviors.
Conclusion: Despite the diversity of health system philosophies and approaches, none of the health systems were effective at addressing health care inaccessibility and or unmet need for vulnerable population groups. Health systems in high income countries must acknowledge that access to healthcare is an important component of a healthy population; knowledge development of specific strategies to improve health within communities is equally important. Health systems in the three countries lack strategies that proactively engage, reach-out to and facilitate health care access for vulnerable populations. Nurses must be fully engaged through their work and research within communities to strengthen health systems and improve the health of all.