Effect of delayed appointment on medical care demand

• Background and Objective: Although receiving medical care later rather than sooner reduces patient's service satisfaction and gives an incentive to decrease health service utilization, researchers and policymakers are mostly concerned with financial disparities. This paper investigates the effect of waiting time to get an appointment on medical care demand for all population and by insurance status in the U.S. Few studies have provided empirical evidence on how people respond to delayed appointment and how the effect varies across different financial condition in their medical service utilization.

• Methods: I use the Community Tracking Study Household Survey collected during 1998 and 2003. This is a nationally representative public use file, and individual level survey data which is randomly selected in sixty sites in the U.S. The sample population contains 138,473 non-elderly, non-Medicare covered individuals. I use negative binomial estimation model and examine the effect of increased appointment wait on number of physician visits during the last 12 months.

• Results: On average, an individual visits physician 3.32 times per year and waits 16.2 days until the next appointment. The uninsured visits physician much less (1.84 times per year) but the appointment wait time is not longer than average (13.9 days). However, the effect of delayed appointment is dramatically aggravated when it is associated with no insurance: When appointment wait time increases 100 percent, the uninsured reduces medical care demand by 46.8 percent (p < 0.001) while an individual decreases medical care utilization by 13.6 percent (p < 0.001) among all sample population.

• Conclusion: Delayed appointment discourages medical care demand significantly both in magnitude and statistical significance. The effect is largest among the uninsured, who are the mostly underserved population due to financial limitation. Knowing the effect of delayed appointment on health care utilization would provide valuable information to policymakers as they are interested in efficient and equivalent health care provision: For example, several states currently are considering whether they should introduce universal health insurance. However, given that the medical care supply is fixed in the short run, if the expanded health insurance increases medical care demand, which subsequently increases the waiting time for the next appointment, the effect of expanded health insurance would be partly offset by the effects of delayed appointment.