Longer wait times affect future use of VHA primary care

Abstract

BackgroundImproving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. MethodsThis observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP). Primary care use was defined as the number of face-to-face visits from VHA and Medicare in the 12 months following SHEP completion. VHA reliance was defined as the number of VHA visits divided by total visits (VHA+Medicare). Wait times were derived from SHEP responses measuring the usual number of days to a VHA appointment with patients’ primary care provider for those seeking immediate care. We defined appointment wait times categorically: 0 days, 1day, 2–3 days, 4–7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. ResultsMean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0day waits. Compared with these patients, reliance over the subsequent year was 1.4 (p = 0.041), 2.8 (p = 0.001) and 1.6 (p = 0.014) percentage points lower for patients waiting 2–3 days, 4–7 days and >7 days, respectively. ConclusionsPatients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. ImplicationsLonger wait times may reduce care continuity and impact cost shifting across two federal health programs.