Access to and utilization of healthcare are distinct, yet related, concepts that serve as a focus for health policy and quality improvement. This article identifies their similarities and differences, calling on previous research and reviews to elaborate on a current understanding of factors that influence both, with a particular focus on those related to the healthcare provider. Access describes an individual's ability to position oneself to receive healthcare services. Utilization presumes access and includes the formulation of a healthcare plan during a healthcare encounter and its subsequent implementation. We present a framework that envisions access and utilization as aspects of healthcare delivery that may be affected by the context within which services are delivered, the structure of the practice that delivers them and other processes leading to outcomes experienced by the healthcare consumer. Based on current trends, we anticipate that research and policy related to access and utilization over the next 5 years will be primarily driven by a focus on quality improvement. Providers are positioned to use their collective authority to exercise influence on access and quality at the individual, institutional and policy levels.