Priority access to health care: Evidence from an exogenous policy shock

Yee, Christine; Legler, Aaron; Davies, Michael L.; Prentice, Julia C.; Pizer, Steven D.

doi:10.1002/hec.3982

Cited by 6 publications

(15 citation statements)

References 22 publications

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“…Finally, carving out access for new patients by simply not scheduling returning patient visits more than 3 months in advance is associated with a significant reduction in wait times. Yee et al (2020) found that rescinding the Recall Reminder scheduling policy (and allowing returning patients to schedule in advance) effectively increased wait times by 14%.…”

Section: Discussionmentioning

confidence: 99%

“…Between September 2010 and May 2016, the VHA instituted a nationwide policy called the Recall Reminder policy, which limited access to the schedule for established patients and improved access for new patients. Yee et al (2020) showed that the wait time for new patients seeking primary care appointments was strongly affected by whether established patients had special access to scheduling their follow-up appointments. In many medical centers, established patients tend to crowd out new patients by scheduling their appointments months in advance.…”

Section: Empirical Modelmentioning

confidence: 99%

“…Moreover, due to scheduling in advance, the schedule in general was filled with appointments that would later be cancelled. We created the same Recall Reminder policy variable as that used in Yee et al (2020). It measures the scheduling advantage of established patients (i.e., non-compliance to the Recall Reminder policy) by the proportion of established patient primary care appointments that were booked more than 3 months in advance.…”

Section: Empirical Modelmentioning

confidence: 99%

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Provider supply and access to primary care

et al. 2022

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Resource‐constrained delivery systems often have access issues, causing patients to wait a long time to see a provider. We develop theoretical and empirical models of wait times and apply them to primary care delivery by the U.S. Veterans Health Administration (VHA). Using instrumental variables to handle simultaneity issues, we estimate the effect of clinician supply on new patient wait times. We find that it has a sizable impact. A 10% increase in capacity reduces wait times by 2.1%. Wait times are also associated with clinician productivity, scheduling protocols, and patient access to alternative sources of care. The VHA has adopted our models to identify underserved areas as specified by the MISSION Act of 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Empirical Modelmentioning

confidence: 99%

Section: Empirical Modelmentioning

confidence: 99%

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Provider supply and access to primary care

et al. 2022

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“…Thus, SM may enhance access across age groups to improve communication, system navigation, and potentially patient activation reducing the need for in-person visits. However, it may also yield disparate access for new versus established patients 23,24 as in many health systems it is at the first in-person appointment that patients gain access to web portal sign-up information. It is also worth noting that a patient portal account does not imply active portal use.…”

Section: Discussionmentioning

confidence: 99%

Association of Secure Messaging with Primary Care In-Person and Telephone Visits Among Veterans: a Matched Difference-in-Difference Analysis

O'Shea

Batten

et al. 2021

J GEN INTERN MED

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BACKGROUND: Secure messaging (SM) between patients and primary care teams has expanded care access but may impact other clinical encounters. OBJECTIVE: To study associations between SM use and primary care in-person and telephone visits in the Veterans Health Administration (VHA). DESIGN: The SM feature of VHA's patient portal, MyHealtheVet, supports asynchronous communication between patients and primary care teams. To study the impact of SM on in-person and telephone visits, two analyses were performed: (1) a retrospective pre-/post-analysis comparing changes after initiating SM use and (2) a difference-in-difference comparison among SM users and non-users 1 year before and after index SM use. Matching to non-users was by primary care team, demographics, and predicted propensity of SM use by Nosos comorbidity score and drive time to clinic. PATIENTS: In 2016, 154,053 Veterans initiated SM from all primary care patients (N = 5,891,893); 25,683 were propensity-matched to controls (N = 49,266) from the same primary care team not using SM. MAIN MEASURES: Primary care provider in-person visits and telephone contacts between patients and their primary care team were assessed 1 year prior and post index SM. KEY RESULTS: Overall, primary care in-person visits decreased 13.3% (p < 0.0001); telephone visits increased 13.5% (p < 0.0001). In the matched analysis, in-person primary care visits decreased by 16.0% (p < 0.0001) by SM users and 9.9% (p < 0.0001) among controls, resulting in a across-group decrease of 6.1% in-person visits after SM initiation. Telephone visits increased by 11.0% (p < 0.0001) for SM users and 4.5% for controls (p < 0.0001) resulting in an across-group increase of 6.5% telephone visits after SM initiation. CONCLUSIONS: Use of SM was associated with decreased in-person visits and increased telephone visits. This may improve clinic appointment availability, while increasing time commitments for providers for nontraditional forms of access.

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“…Based on the above analysis dimensions of the accessibility of healthcare services for the elderly and the construction principles of the index system, this paper establishes an accessibility index system of healthcare services for the elderly that includes potential accessibility, realized accessibility, and sustainable accessibility, according to the existing research results of accessibility of healthcare services for the elderly and the construction practice of local government [ 29 , 30 , 31 ]. The index system includes 3 first level indicators, 12 secondary level indicators, and 23 measurement indicators, as shown in Table 2 .…”

Section: Analysis Framework and Index Systemmentioning

confidence: 99%

Assessing the Accessibility of Home-Based Healthcare Services for the Elderly: A Case from Shaanxi Province, China

Di¹,

Wang²,

Dai³

et al. 2020

IJERPH

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With the rapid increase of the elderly population in China, healthcare services for the elderly have gradually become an important welfare resource. However, the healthcare service for the elderly still has problems such as mismatched supply and demand and unbalanced resources. In order to effectively eliminate the path barriers to match supply and demand, and improve the accessibility of healthcare services, this paper introduces the sustainability of the healthcare service based on the accessibility theory, and constructs an index system from the three dimensions of potential accessibility, realized accessibility, and sustainable accessibility of healthcare services for the elderly. Then, the paper makes a practice application of the index system based on survey data of healthcare services from Shaanxi province, China. Finally, the paper finds that the total accessibility and sustainable accessibility of healthcare services for the elderly in Shaanxi Province are at an average level. The score of potential accessibility is high, indicating that elderly people have greater opportunities to use healthcare services. The realized accessibility score is low, which indicates that the actual use of healthcare services for the elderly presents low satisfaction.

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Priority access to health care: Evidence from an exogenous policy shock

Cited by 6 publications

References 22 publications

Provider supply and access to primary care

Provider supply and access to primary care

Association of Secure Messaging with Primary Care In-Person and Telephone Visits Among Veterans: a Matched Difference-in-Difference Analysis

Assessing the Accessibility of Home-Based Healthcare Services for the Elderly: A Case from Shaanxi Province, China

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