 The use-per-need approach is quite sensitive to what actual measures of both need and utilization are used. A process variable—for example, time spent in a waiting room—may have a significant effect on measures of satisfaction with care (a subjective measure of actual access), but have relatively little effect on utilization rates (an objective measure of actual access). So the choice of objective or subjective measures of realized access may yield different assessments of the importance of a process variable and, ultimately, of the equity of access to health-care services. Even if we are inclined to use an objective measure, however, it matters which one. For example, cultural attitudes toward entering a sick role might have a greater impact on disability days, as a measure of need, than they do on the more serious level of need, bed-disability days.