Examining Differences in Wait Times for Primary Care in the Veterans Health Administration (VA) by Race and Ethnicity: What Role Do Within-facility and Between-facility Differences Play?

Rosen AK, Beilstein-Wedel E, Gurewich D, Davila H, Shwartz M. Examining Differences in Wait Times for Primary Care in the Veterans Health Administration (VA) by Race and Ethnicity: What Role Do Within-facility and Between-facility Differences Play? Medical care. 2026 Jan 5 DOI: 10.1097/MLR.0000000000002279.

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Abstract:

BACKGROUND: Prior studies at the national level indicate that primary care wait times exceeded the 20-day veterans Health Administration (VA) wait time standards set for primary care. Longer wait times were also reported for Black and Hispanic versus White veterans. OBJECTIVES: Examine variation in wait time for primary care at the facility level by race and ethnicity over time and determine whether differences are due to within-facility differences (ie, at the same facility) or between-facility differences (ie, differences in facilities used). RESEARCH DESIGN: Observational study using VA and Community Care (CC) data from Fiscal Year (FY) FY2021 to FY2023. SUBJECTS: All veterans (n = 642,180) who had an outpatient primary care consult in VA or CC. MEASURES: Wait time for an outpatient primary care consult. METHODS: We used multivariate regression models calculated using all 3 FYs combined and separately by FY models to predict consult wait times. We then used the Kitagawa decomposition to partition differences in mean adjusted wait times between Hispanic/Black veterans and White veterans into within-facility differences and between-facility differences. RESULTS: Overall, Hispanic veterans waited on average 6.7 days longer than White veterans, attributed to longer wait times within the same facility. Black veterans waited 1.2 days less than White veterans, partially accounted for by their higher use of facilities with shorter wait times for all veterans. Within-facility results were reasonably stable across FYs. CONCLUSIONS: Continued investigation at the local level is important for ensuring timely access to primary care for all racial and ethnic groups.