Access is seen as a reflection of a community's (nation's) relative values, which may reflect tradeoffs between ethical principles (e.g. between equality/"justice" and individual responsibility/"autonomy") and fundamental purposes. Compare, for example, the fragmented health insurance system in the U. S. with the nationalized systems in Scandanavial nations that cover essentially all citizens and even contain some prohibitions against care outside the system in order to assure that even the most powerful have an interest in the quality and accessibility of the national system.

The presumption that access is a determinant of health (as well as utilization of health care) has been sustained by research. Good research on the topic, however, is difficult and expensive. Thus there is only limited understanding of  how insurance (its existence, its co-pays, etc.) affects treatment, and how the differences in treatment that are caused by differences in insurance affect health.