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APHA Scientific Session and Event Listing

Julia C. Prentice, PhD, Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, 200 Springs Road, (152), Bedford, MA 01730, 781-687-2882, jprentic@bu.edu and Steven D. Pizer, PhD, Health Care Financing and Economics, Department of Veterans Affairs, 150 South Huntington Avenue, Mail Stop 152H, Boston, MA 02130.

Long waits for healthcare have been found to negatively impact patient satisfaction and contribute to an inefficient healthcare system by increasing the use of the emergency room for non-urgent conditions. Policymakers argue long waits will result in delays in diagnosis and treatment, and these delays are hypothesized to negatively affect individual health. Despite the assumption that timely access to care affects health outcomes, little research has actually examined the empirical association between how long patients wait for outpatient care and their health outcomes. This is likely due to lack of data. Estimates of how long individuals wait for healthcare are largely based on self-reported data. Data collected by the Veterans Health Administration (VA) are an important exception because VA is one of the only health care systems in the U.S. that automatically collects data on the number of days between appointment requests and when appointments are scheduled (e.g. wait times). Using these unique data, this study examines the relationship between waiting for VA outpatient health care and health outcomes. Veterans aged 65 and over were included in the sample. The average VA facility-level wait time for outpatient care at 89 medical centers in 2001 was the main explanatory variable of interest. Logistic regression and heteroskedastic probit models that included 1) facility-level wait times for outpatient care, 2) standard risk-adjustors for prior individual health status and 3) facility-level differences in case-mix predicted the probability of dying within a six month follow-up period and experiencing a preventable hospitalization within a three month follow-up period. Veterans who visited a VA medical center with facility-level wait times of 32 days or more had significantly higher odds of mortality (odds ratio=1.20, p=0.019) compared to veterans who visited a VA medical center with facility-level wait times of less than 32 days. Similarly, veterans visiting VA medical centers with longer facility-level wait times were significantly more likely to experience a preventable hospitalization compared to veterans visiting a medical center with shorter wait times. Our findings support the widely assumed association between long wait times for outpatient health care and negative health outcomes. Healthcare systems outside of the VA should systematically monitor wait times. Future research should focus on the causes of long waits for health care and effective policies to decrease long wait times.

Learning Objectives: At the end of the session, the participant will be able to

• Articulate the relationship between waiting for health care and health outcomes and
• Develop appropriate measures of waiting for health care

Keywords: Access to Health Care, Mortality

Presenting author's disclosure statement:

Any relevant financial relationships? No