 Critics of the use-per-need account argue that some process variables are important determinants of equity of access even if they do not have a significant impact on utilization of services (Sloan and Bentkover 1979). For example, even if waiting time does not interfere with utilization, it may impose a significant burden on those seeking care, and that burden may be inequitable. Another criticism of the use-per-need account is the claim that uniformity in utilization rates is not even a necessary condition for equity of access. If some people are informed, yet averse to the utilization of medical services, then differences in their utilization rate from others should not count as an inequity of access. A further objection is that the approach abstracts from the effectiveness of care—it does not look at health status as an outcome, only the utilization of services. People with different utilization rates may have the same health status as an output simply because the care was ineffective, so measuring its rate of utilization does not tell us what really matters.