• Financial (e.g., insufficient monetary resources; lack of insurance).
• Geographic (e.g., distance to providers; inability to travel to services due to lack of transportation, time or disability).
• Organizational (e.g., lack of available providers)
• Sociological (e.g., discrimination based on gender, racial, ethnic, sexual preference, age; language and cultural barriers; health beliefs).
• Educational (e.g., lack of knowledge about the healthcare delivery system and options available once services are required; paternalistic healthcare delivery that encourages consumer passivity.)

Any effort to improve access, be it providing/improving health insurance coverage or increasing the availability of providers in underserved areas, requires spending. Impacts on quality are generally positive (i.e., any care is better than no care); however, clearly some access initiatives can have a more positive impact on quality than others. The US has the best health care in the world, provided the patient has the right disease, the right insurance and is in the right health care facility seeking treatment from the right provider mix. This long list of qualifiers, creates enormous opportunitie3s to improve quality, reduce the huge geographic variation in how care is delivered and increase access to care.