title: Delayed access to health care and mortality.
abstract: OBJECTIVE
  To measure the relationship between time spent waiting for health care services and patients' mortality.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Health Care Financing and Economics, VA Boston Health Care System, 150 Huntington Avenue, Mail Stop 152H, Boston, MA 02130, USA.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Prentice
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pizer
mesh_terms: D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D009026:Mortality; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014850:Waiting Lists