Effect of waiting for primary care on diabetes management

The Institute of Medicine's Committee on the Quality of Health Care in America highlighted reducing delays for healthcare as one way to improve the quality of America's health care system. Delayed access to health care is assumed to negatively affect health outcomes through decreased or foregone health care utilization that delays diagnosis and treatment. The few studies to examine this assumption confirm these concerns by finding a significant association between longer waits for healthcare and health outcomes, such as mortality and ambulatory care sensitive condition (ACSC) hospitalizations, among a geriatric sample of veterans. This study enhances our understanding of the effect of wait times on health outcomes by focusing on a clinically homogeneous population of patients diagnosed with diabetes. Complications from diabetes can be prevented or minimized with timely outpatient care that focuses on controlling blood glucose (HbA1C levels) and monitoring early signs of complications. The sample included veterans diagnosed with diabetes who relied exclusively on the VA for outpatient care in 2001. The main explanatory variable of interest was VA facility-level primary care wait times. Long-term health outcomes include mortality, heart attack, stroke and ACSC hospitalization. The short-term health outcome was the percent of glycated hemoglobin (HbA1C) in the blood. Stacked logistic regression models predicted the probability of experiencing each health outcome in 2002 and 2003 with wait time as a predictor. Models were risk adjusted for prior individual health status and included facility-level fixed effects. Longer wait times were significant predictors of mortality, heart attack and ACSC hospitalization for veterans aged 80 or older. No relationship was found between wait times and long-term health outcomes for other age groups. Longer wait times were significantly associated with higher HbA1C values among all age groups. Longer wait times for primary care have a significant negative impact on short and long-term health outcomes among patients diagnosed with diabetes. Outside of the VA, patients in the United States have not traditionally experienced rationing by waiting lists because the uninsured and underinsured receive rationed care through their inability to pay. However, a major expansion of health insurance is currently being proposed in Congress. This expansion without the concomitant expansion in supply of health care services to respond to the increased demand will result in longer waits for all patient populations. Policymakers should begin considering measures to manage wait times and ways to provide appropriate populations, such as those with chronic disease, priority access.