Waiting times in the ambulatory sector - the case of chronically Ill patients

Aims: First, the influence of determinants on the waiting times of
chronically ill patients in the ambulatory sector is investigated.
The determinants are subdivided into four groups: (1) need, (2)
socio-economic factors, (3) health system and (4) patient time
pressures. Next, the influence of waiting times on the annual
number of consultations is examined to assess whether the existing
variation in waiting times influences the frequency of medical
examinations. The waiting times of chronically ill patients are
analysed since regular ambulatory care for this patient group could
both improve treatment outcomes and lower costs. Data sources:
Individual data from the 2010 Representative Survey conducted by
the National Association of Statutory Health Insurance Physicians
(KBV) together with regional data from the Federal Office of
Construction and Regional Planning. Study design: This is a
retrospective observational study. The dependent variables are
waiting times in the ambulatory sector and the number of
consultations of General Practitioners (GPs) and specialist
physicians in the year 2010. The explanatory variables of interest
are `need' and `health system' in the first model and `length of
waiting times' in the second. Negative binomial models with random
effects are used to estimate the incidence rate ratios of increased
waiting times and number of consultations. Subsequently, the models
are stratified by urban and rural areas. Results: In the pooled
regression the factor `privately insured' shortens the waiting time
for treatment by a specialist by approximately 28\% (about 3 days)
in comparison with members of the statutory health insurance
system. The category of insurance has no influence on the number of
consultations of GPs. In addition, the regression results
stratified by urban and rural areas show that in urban areas the
factor `privately insured' reduces the waiting time for specialists
by approximately 35\% (about 3.3 days) while in rural areas there
is no evidence of statistical influence. In neither of the models,
however, does the waiting time have a documentable effect on the
number of consultations in the ambulatory sector. Conclusions: In
our random sample, characteristics of the health care system have
an influence on the waiting time for specialists, but the waiting
time has no documentable effect on the number of consultations in
the ambulatory sector. In the present analysis this applies to
consultations of both GPs and specialists. Nevertheless, it does
not rule out the possibility that the length of waiting times might
influence the treatment outcomes of certain patient populations.