Longer wait times affect future use of VHA primary care

Edwin S. Wong, Chuan Fen Liu, Susan E. Hernandez, Matthew R. Augustine, Karin Nelson, Stephan D. Fihn, Paul L. Hebert

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Improving 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. Methods: This 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, 1 day, 2–3 days, 4–7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. Results: Mean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0 day 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. Conclusions: Patients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. Implications: Longer wait times may reduce care continuity and impact cost shifting across two federal health programs.

Original languageEnglish
Pages (from-to)180-185
Number of pages6
Issue number3
StatePublished - Sep 2018
Externally publishedYes


  • Access to care
  • Medicare
  • Primary care
  • Utilization
  • Veterans


Dive into the research topics of 'Longer wait times affect future use of VHA primary care'. Together they form a unique fingerprint.

Cite this