Purpose - The purpose of this paper is to provide a general review about the major programs and factors characteristic of major changes in the health care access, from both consumer and provider perspectives. Customers' perspective emphasizes the fiscal control, with particular focus on the agencies that function as fiscal intermediaries and enablers, such as insurance companies. Providers' perspective concentrates on providers of health care services, such as physicians, nurses, technicians as well as various types of medical care facilities. Design/methodology/approach - Historical approach was adopted to address the health care access issue, a general concept that summarizes the specific dimensions describing the fit between the patient and the health care system. Findings - It is self-evident that reform is needed and that major efforts should be made to remedy shortcomings in order to safeguard the health and welfare of the nation. Originality/value - To achieve the goal of a truly caring commonwealth, we must improve quality and safety in health care, increase access and utilization of technology, promote greater consumer involvement at all stages, restructure the medical malpractice system to reach all who may be injured by systemic errors, and develop sustainable financing less subject to the vagaries of state revenues. However, the access issue still remains a basic and important problem we have to confront. © Emerald Group Publishing Limited.