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Delayed Access to Health Care and Mortality
Author(s) -
Prentice Julia C.,
Pizer Steven D.
Publication year - 2007
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2006.00626.x
Subject(s) - medicine , veterans affairs , reimbursement , odds , health care , logistic regression , observational study , odds ratio , retrospective cohort study , medical diagnosis , health facility , demography , emergency medicine , family medicine , medical emergency , environmental health , health services , population , pathology , sociology , economics , economic growth
Objective. To measure the relationship between time spent waiting for health care services and patients' mortality. Data Source. Data on the number of days until the next available appointment at 89 Veterans Affairs (VA) medical centers in 2001 were extracted from a VA administrative database. These facility‐level data were merged with individual‐level data for a sample of veterans who visited a VA geriatric outpatient clinic in 2001. The merged dataset includes facility‐level data on waiting times and individual‐level data on demographics, health status (e.g., diagnoses), and mortality. Study Design. This was a retrospective observational study using secondary data from administrative sources. The dependent variable was mortality within a 6‐month follow‐up period. The main explanatory variable of interest was VA facility‐level wait times for outpatient visits measured in number of days. Random effects logistic regression models were risk adjusted for prior individual health status and facility‐level differences in case mix. Principal Findings. Veterans who visited a VA medical center with facility‐level wait times of 31 days or more had significantly higher odds of mortality (odds ratio=1.21, p =0.027) compared with veterans who visited a VA medical center with facility‐level wait times of <31 days. Conclusions. Our findings support the largely assumed association between long wait times for outpatient health care and negative health outcomes, such as mortality. Future research should focus on the causes of long waits for health care (e.g., physician reimbursement levels), the consequences of long waits in other populations, and effective policies to decrease long waits for health care services.