title: The effect of in-office waiting time on physician visit frequency among working-age adults.
abstract: Disparities in unmet health care demand resulting from socioeconomic, racial, and financial factors have received a great deal of attention in the United States. However, out-of-pocket costs alone do not fully reflect the total opportunity cost that patients must consider as they seek medical attention. While there is an extensive literature on the price elasticity of demand for health care, empirical evidence regarding the effect of waiting time on utilization is sparse. Using the nationally representative 2003 Community Tracking Study Household Survey, the most recent iteration containing respondents' physician office visit frequency and estimated in-office waiting time in the United States (N = 23,484), we investigated the association between waiting time and calculated time cost with the number of physician visits among a sample of working-age adults. To avoid the bias that literature suggests would result from excluding respondents with zero physician visits, we imputed waiting time for the essential inclusion of such individuals. On average, respondents visited physician offices 3.55 times, during which time they waited 28.7 min. The estimates from a negative binomial model indicated that a doubling of waiting time was associated with a 7.7 percent decrease (p-value < 0.001) in physician visit frequency. For women and unemployed respondents, who visited physicians more frequently, the decrease was even larger, suggesting a stronger response to greater waiting times. We believe this finding reflects the discretionary nature of incremental visits in these groups, and a consequent lower perceived marginal benefit of additional visits. The results suggest that in-office waiting time may have a substantial influence on patients' propensity to seek medical attention. Although there is a belief that expansions in health insurance coverage increase health care utilization by reducing financial barriers to access, our results suggest that unintended consequences may arise if in-office waiting time increases.
authors.affiliation: Department of Health Management and Policy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, EAD 601R, Fort Worth, TX 76107, USA. Electronic address: hyojung.tak@unthsc.edu.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Tak
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5000, Chicago, IL 60637, USA; The Center for Health and the Social Sciences, University of Chicago, 5841 South Maryland Avenue, MC 1000, Chicago, IL 60637, USA. Electronic address: ghougham@bsd.uchicago.edu.
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Hougham
authors.affiliation: Chicago, IL 60615, USA. Electronic address: atsuko.daibo@gmail.com.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ruhnke
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5000, Chicago, IL 60637, USA. Electronic address: gruhnke@medicine.bsd.uchicago.edu.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Ruhnke
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010820:Physicians; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D014850:Waiting Lists
keywords: Health policy; Medical care demand; Time cost; USA; Waiting time