What Are the Consequences of Waiting for Health Care in the Veteran Population?

Abstract

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 subpopulations 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.

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

“…A number of previous studies on conditions ranging from peripheral vascular disease to colon cancer have demonstrated that uninsured or under-insured patients present later and with more advanced disease than patients with private insurance resulting in disparities in disease outcomes [58][59][60][61][62][63][64][65]. Timely access to care is particularly important to optimize outcomes for acute conditions in need of rapid definitive treatment such at stroke and myocardial infarction [58,59].…”

Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

“…Delays in accessing care have occurred for patients seeking outpatient primary and specialty care within VA (U.S. Government Accountability Office, 2012Office, , 2013aOffice, , 2014b. Veterans who received care at VA facilities with longer wait times were at increased risk of adverse long-term health outcomes (e.g., preventable hospitalizations) and intermediate outcomes (e.g., worse hemoglobin A1C levels) than Veterans receiving care at facilities with shorter wait times (Pizer & Prentice, 2011). The increase in wait times and associated adverse health outcomes were responsible, in part, for the greater use of technological methods to deliver care (e.g., messaging between patients and providers, telehealth) (U.S. Government Accountability Office, 2013a), and the development of legislation that expanded VA coverage to allow enrolled Veterans to seek VA-purchased care from community providers.…”

“…Veterans are less likely than patients in the private sector to report getting appointments as soon as needed. (RAND Health, 2015) In recent years, VA wait times have increased, resulting in a slight decrease in utilization, as well as adverse health outcomes among vulnerable Veterans (Pizer & Prentice, 2011). Delays in accessing care have occurred for patients seeking outpatient primary and specialty care within VA (U.S. Government Accountability Office, 2012Office, , 2013aOffice, , 2014b.…”

Metrics That Matter

“…These clinical outcomes are not likely to be related to metrics that fail to measure access and unmet health care needs. 8,[13][14][15][16][17][18] Two key lessons emerged from this validation work. First, different access metrics predicted satisfaction for different patient populations.…”

“…A common strategy to address this problem is to compute facility-level average metrics that exclude the individual patient whose outcome is being assessed. 8,[13][14][15][16][17][18] This is a similar approach to using an instrumental variable analysis that allows consistent estimation of relationships between explanatory variables and outcomes even when key explanatory variables are correlated with the error terms in the models.…”