Ensuring equitable access to care for marginalized groups remains one of the most pressing challenges for health systems across Europe. In line with EHTEL’s commitment to digital transformation, health data, and integrated care, the EQUICARES project explores innovative approaches to address healthcare inequalities. Using and adapting tools such as the Levesque Framework, EQUICARES supports community-based co-creation of scalable solutions, whether digitally-enabled or not, and the development of policy recommendations.

As a collaborative effort, EQUICARES aims to improve access to person-centred care for people in vulnerable situations across Europe through the application of an assessment framework and innovative tools.

What Is the Levesque Framework?

The Levesque Framework is a dynamic, multidimensional model for analysing access to health care. The framework was developed by Jean-Frederic Levesque, a globally-experience public health expert, and colleagues in 2013. It defines access as an iteration involving health systems (the supply side) and populations (the demand side) along five dimensions: Approachability, Acceptability, Availability and Accommodation, Affordability, and Appropriateness (the five “As”).

A conceptual framework of access to health care. Copyright ©2013 Levesque et al.

Why is the Levesque Framework relevant to EHTEL?

For EHTEL members - who span public authorities, hospitals, patient organizations, to digital health innovators—the Levesque Framework offers a practical and conceptual bridge between health service design and citizen experience. It can be particularly useful in these four domains:

Digital health and equity

As digital health tools proliferate, it is critical to ensure that all population groups can perceive, seek, reach, and engage with services. The Levesque Framework supports the assessment of digital health literacy, cultural barriers, and technical capacity gaps across diverse, vulnerable user groups.

Integrated long-term care (I-LTC)

The Levesque Framework is well suited to assessing access in complex care pathways, such as those for frailty and dementia. EHTEL members working on EU projects like COMFORTage or Laurel can apply the framework to assess not just service provision, but also  informal carers engagement and coordination across sectors.

Service co-design and policy feedback

Because the Levesque Framework emphasizes both user experiences and system features, it is useful for evaluating reforms, planning services, and designing digital tools with communities. It invites reflection on the key barriers to access and fosters co-creation of healthcare systems with communities.

Monitoring and benchmarking

Although some dimensions of the Levesque Framework are often underused, applying even a subset of the framework (e.g. “Ability to Engage”) can be helpful. EHTEL partners can use these subsets to develop indicators and benchmarks for inclusive health access strategies—especially in frontline digital systems and hybrid care models.

Implementation considerations

In addition, EHTEL members and others should be alert to the benefits of using the Levesque Framework when implementing digital health services:

• Flexible use: Studies have shown that the framework can be used partially by focusing on dimensions most relevant to project or policy goals. This makes it adaptable for pilots, policy reforms, or national digital health evaluations.
• Data categorization: A common challenge in implementation is in categorizing data under specific dimensions, especially where indicators overlap. A mixed-method approach and participatory validation can help navigate this challenge.

A call to action for EHTEL members

Incorporating the Levesque Framework into project planning, user research, and policy assessments can empower EHTEL members to build more inclusive, people-centred digital health systems. Whether designing patient portals, integrating and sharing social care data, or addressing digital exclusion, the framework provides a reference for evaluating not just what is offered, but how and by whom it is accessed.

Let us know how we can help you to know the Levesque Framework better.

Check out Equicares’ LinkedIn account for frequent project updates.

Contact EHTEL's Digital Health Policy Advisor, Sophia Schlette, to learn more about the Levesque Framework.

Take a look at the official project website.