What Are the Consequences of Waiting for Health Care in the Veteran Population?
- 951 Downloads
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
- 1.The Committee on the Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington D.C: Institute of Medicine; 2001.Google Scholar
- 2.Fortney JC, Burgess JF, Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare, J Gen Intern Med. In press. doi: 10.1007/s11606-011-1806-6
- 4.Congressional Budget Office. Key issues in analyzing major health insurance proposals. Washington D.C.; 2008. http://www.cbo.gov/ftpdocs/99xx/doc9924/toc.shtml [Accessed on October 13, 2010].
- 5.Kowalczyk L. Across Mass., waits to see the doctor grows. The Boston Globe. September 22, 2008.Google Scholar
- 11.The doctor will see you in 3 months. Bloomberg Businessweek, 2007.Google Scholar
- 14.Prentice JC, Fincke BG, Miller DR, Pizer SD. Waiting for primary care and health outcomes among elderly patients with diabetes. Health Serv Res. In Press.Google Scholar
- 15.Prentice JC, Fincke BG, Miller DR, Pizer SD. Outpatient waiting times and diabetes care quality improvement. Am J Managed Care. 2011;17(2):e43–e54.Google Scholar
- 16.United States General Accounting Office. VA needs better data on extent and causes of waiting times; 2000. GAO/HEHS-00-90.Google Scholar
- 17.United States General Accounting Office. More national action needed to reduce waiting times, but some clinics have made progress. 2001:22 GAO-01-953.Google Scholar
- 18.Department of Veterans Affairs. Priority for outpatient medical services and inpatient hospital care: 2002. VHA Directive 2002–059.Google Scholar
- 19.Department of Veterans Affairs. Process for managing patients when patient demand exceeds current clinical capacity: VHA Directive 2003.2003-068.Google Scholar
- 20.Department of Veterans Affairs. Process for ensuring timely access to outpatient clinical care: 2006. VHA Directive 2006–028.Google Scholar
- 21.Department of Veterans Affairs. VHA outpatient scheduling processes and procedures 2010. 2010. VHA Directive 2010–027.Google Scholar
- 23.Yang Z, Gilleskie DB, Nortaon EC. Prescription drugs, medical care and health outcomes: a model of elderly health dynamics: University of North Carolina; 2006.Google Scholar
- 24.AHRQ wuality indicators-Guide to prevention wuality indicators: hospital sdmission for ambulatory care sensitive conditions. Rockville, MD: Agency for Healthcare Research and Quality; 2001. 02-R0203.Google Scholar
- 25.Wang G, Zhang Z, Ayala C, Wall HK, Fang J. Cost of heart failure-related hospitalizations in patients aged 18 to 64 years. Am J Managed Care. 2010;16(10):769–776.Google Scholar
- 26.Pizer SD, Prentice JC. Time Is money: delayed access to outpatient care and health insurance choices of elderly veterans in the United States. J Health Econ. In press.Google Scholar
- 27.Baar B. New patient monitor: data definitions: Veteran Health Administration Support Services Center; 2005.Google Scholar
- 30.Solberg LI, Maciosek MV, Sperl-Hillen JM, et al. Does improved access to care affect utilization and costs for patients with chronic conditions? Am J Managed Care. 2004;10(10):717–722.Google Scholar
- 32.Knight K, Badamgarav E, Henning JM, et al. A systematic review of diabetes disease management programs. Am J Managed Care. 2005;11:242–250.Google Scholar
- 39.Sabik LM, Lie RK. Priority setting in health care: lessons from the experiences of eight countries. Int J Equity Health. 2008;7(4):1–13.Google Scholar
- 41.Congressional Budget Office CB. Quality initiatives undertaken by the Veterans Health Administration; 2009. http://www.cbo.gov/ftpdocs/104xx/doc10453/08-13-VHA.pdf [Accessed on October 21, 2010]
- 42.Lukas CV, Meterko M, Mohr D, Seibert MN. The implementation and effectiveness of advanced clinicaccess. HSR&D Management Decision and Research Center. Boston: Office of Research and Development, Department of Veteran Affairs; 2004:80.Google Scholar
- 43.Congressional Budget Office. The potential cost of meeting demand for veterans’ health care. 2005. http://www.cbo.gov/ftpdocs/61xx/doc6171/03-23-Veterans.pdf [Accessed on September 28, 2010].
- 44.Young BA, Lin E, Korff MV, Simon G, Ciechanowski P, Ludman EJ, Everson-Stewart S, Kinder L, Oliver M, Boyko EJ, Katon WJ. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Managed Care. 2008;14(1):15–24.Google Scholar