Paying for Health Care with Time

Have you ever sat in your doctor’s
waiting room, thinking about everything else you could be doing. For example you
could be exercising, you could be working, or you could be with loved ones. The amount of time that patients spend
seeking help care for themselves or for a loved one can be a major burden, taking
time away from other more productive more enjoyable activities. We can measure this time burden in minutes, and we can then translate this time burden into
opportunity costs. Opportunity costs are the monetary value of time spent on an
activity. In this way the time you spend traveling to or waiting at the doctor’s
office can translate to a monetary value. In two studies we measured the total
time that patients spend on outpatient visits, including time traveling, time
waiting, and time with the physician. In one study we translated this total time and opportunity cost. In a second study we examined differences in time burdened by patients race, ethnicity, and socioeconomic status. Using the American Time Use Survey, we studied the time of nearly 4,000 people seeking medical care. 2889 of these people were seeking
medical care for themselves, 530 were seeking medical care for
another adult, and six hundred and seven were seeking medical care for a child. We found that the average total visit time
was 121 minutes, including 37 minutes traveling and 84 minutes in the clinic. Out of this clinic time, only 20 minutes were spent with the physician, with the
remaining hour spent with non-physician staff, paying medical bills, completing
forms, or just waiting. When we translated this time and opportunity costs, we found
that the total opportunity cost for the one hundred and twenty one minutes that
adults spend at an ambulatory visit was equal to $43. So what does this mean? Out-of-pocket
costs often weigh on patients who need medical care. We found that opportunity
costs at $43 per visit actually exceeded out-of-pocket costs,
which averaged $32 per visit during the same time period. Applying this opportunity cost the total
number of doctors visits in 2010 we found that the total annual societal
opportunity cost was fifty two billion dollars. To get an estimate of how this
impacts worker productivity, we also determined time burden and opportunity
costs for employed individuals. We estimate that employed adults spend 1.1 billion hours of time and twenty five billion dollars an opportunity costs
annually seeking medical care, which is equivalent to the total annual hours
worked by the employed adult population of Dallas. In our second study we found
that patients’ time with their physicians similar across racial, ethnic, and
socioeconomic groups, but that the total time burden was about 25 percent longer
for racial and ethnic minorities and for the unemployed. Overall we found that
opportunity cost are substantial for patients and for society and that time
burden falls disproportionately on disadvantaged populations. So how do we fix this? First, we must improve efficiency in physician clinical
settings. More than 80% of a patient’s total time seeking care is outside of
face-to-face contact with the physician. Patient wait time could be improved
through improving clinic processes, streamlined visits, and optimized
scheduling. Second, use of non face-to-face care can
also reduce time burden and opportunity costs. Non face-to-face care could
include delivery of health care for videoconferencing, computerized visits, or other electronic communication. Accounting for patient opportunity cost
is important for examining the efficiency of the US health care system.
Focusing on patient opportunity costs and time burden is an important way to
understand the value of innovations to improve the efficiency and
patient-centeredness of healthcare delivery.

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