What Are the Consequences of Waiting for Health Care in the Veteran Population?
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National health reform is expected to increase how long individuals have to wait between requests for appointments and when their appointment is scheduled. The increase in demand for care due to more widespread insurance will result in longer waits if there is not also a concomitant increase in supply of healthcare services. Long waits for healthcare are hypothesized to compromise health because less frequent outpatient visits result in delays in diagnosis and treatment. Research testing this hypothesis is scarce due to a paucity of data on how long individuals wait for healthcare in the United States. The main exception is the Veterans Health Administration (VA) that has been routinely collecting data on how long veterans wait for outpatient care for over a decade. This narrative review summarizes the results of studies using VA wait time data to answer two main questions: 1) How much do longer wait times decrease healthcare utilization and 2) Do longer wait times cause poorer health outcomes? Longer VA wait times lead to small, yet statistically significant decreases in utilization and are related to poorer health in elderly and vulnerable veteran populations. Both long-term outcomes (e.g. mortality, preventable hospitalizations) and intermediate outcomes such as hemoglobin A1C levels are worse for veterans who seek care at facilities with longer waits compared to veterans who visit facilities with shorter waits. Further research is needed on the mechanisms connecting longer wait times and poorer outcomes including identifying patient sub-populations whose risks are most sensitive to delayed access to care. If wait times increase for the general patient population with the implementation of national reform as expected, U.S. healthcare policymakers and clinicians will need to consider policies and interventions that minimize potential harms for all patients.
KEY WORDSwait times health outcomes chronic conditions health care utilization VA
Funding Sources and Acknowledgements
Funding for this research was provided by Grant No: IAD-06-112 and IIR 04–233 from the Health Services Research and Development Service, Department of Veterans Affairs and Grant No: 62967 from the Health Care Financing and Organization Initiative under the Robert Wood Johnson Foundation. Neither author has any conflicts of interest to report. The authors are indebted to Matthew Neuman and John Gardner for programming support. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. This research was approved by the VA Boston Health Care System institutional review board.
Conflict of interest
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