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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3080 — Why Do Some VA Facilities have Long Waits?

Prentice JC (Health Care Financing and Economics (HCFE); VA Boston Healthcare System), Pizer SD (HCFE and Boston University)

Objectives:
The VA has invested significant resources into decreasing wait times for appointments through performance measures and the Advanced Clinic Access Initiative. These initiatives focus on developing a more efficient scheduling environment, which increases facilities’ capacity to provide appointments and decreases waits. However, policies aimed at decreasing wait times have not examined the market characteristics outside of the VA that affect demand for VA services. This research is the first to predict VA facility wait times for outpatient care based on both demand and supply characteristics.

Methods:
Waiting for outpatient care is defined as the number of days between the appointment request and the day the next available appointment can be scheduled among new patients. Monthly wait times were averaged together into a yearly average for each year between 2002 and 2005 for each VA medical center. Using the VA PSSG zip code distance data that defines the nearest VA medical center to each zip code, counties and states served by each VA medical center were defined. County and state market characteristics (e.g. Medicaid restrictiveness measures, HMO penetration) to measure alternatives to VA care and VA medical center supply characteristics (e.g. VA medical center budget) predicted the yearly average wait times using ordinary least squares regression.

Results:
Wait times have significantly decreased in each year between 2002 and 2005. Medical centers that serve areas with a higher number of non-VA general practitioners and greater HMO competition have significantly lower wait times. Medical centers that serve areas with a greater proportion of the population older than age 75 have significantly higher wait times.

Implications:
Market characteristics have a significant effect on VA medical center wait times, with the availability of more non-VA options significantly associated with lower VA wait times.

Impacts:
Substantial progress has been made in reducing VA wait times by focusing on how to increase capacity through changes in scheduling. However, market characteristics that influence the demand for VA services have largely been neglected. To further decrease waits, VA policymakers should target VA facilities in markets with a greater demand for VA services when distributing new VA resources.


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