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 mm. 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. (C) 2014 Elsevier Ltd. All rights reserved.'
affiliation: 'Tak, HJ (Corresponding Author), Univ N Texas, Hlth Sci Ctr, Dept Hlth
  Management \& Policy, 3500 Camp Bowie Blvd,EAD 601R, Ft Worth, TX 76107 USA.

  Tak, Hyo Jung, Univ N Texas, Hlth Sci Ctr, Dept Hlth Management \& Policy, Ft Worth,
  TX 76107 USA.

  Hougham, Gavin W.; Ruhnke, Gregory W., Univ Chicago, Dept Med, Sect Hosp Med, Chicago,
  IL 60637 USA.

  Hougham, Gavin W., Univ Chicago, Ctr Hlth \& Social Sci, Chicago, IL 60637 USA.'
author: Tak, Hyo Jung and Hougham, Gavin W. and Ruhnke, Atsuko and Ruhnke, Gregory
  W.
author-email: 'hyojung.tak@unthsc.edu

  ghougham@bsd.uchicago.edu

  atsuko.daibo@gmail.com

  gruhnke@medicine.bsd.uchicago.edu'
author_list:
- family: Tak
  given: Hyo Jung
- family: Hougham
  given: Gavin W.
- family: Ruhnke
  given: Atsuko
- family: Ruhnke
  given: Gregory W.
da: '2023-09-28'
doi: 10.1016/j.socscimed.2014.07.053
eissn: 1873-5347
files: []
issn: 0277-9536
journal: SOCIAL SCIENCE \& MEDICINE
keywords: USA; Waiting time; Time cost; Medical care demand; Health policy
keywords-plus: 'MEDICAL-CARE; HEALTH-CARE; SERVICES; QUALITY; CENTERS; DEMAND; GENDER;

  COSTS; PRICE'
language: English
month: OCT
number-of-cited-references: '41'
orcid-numbers: Hougham, Gavin Wade/0000-0001-7006-1835
pages: 43-51
papis_id: 3880df2c4deab044850f2983f5700b3e
ref: Tak2014effectinoffice
researcherid-numbers: Hougham, Gavin Wade/F-4554-2012
times-cited: '11'
title: The effect of in-office waiting time on physician visit frequency among working-age
  adults
type: article
unique-id: WOS:000342880900006
usage-count-last-180-days: '3'
usage-count-since-2013: '13'
volume: '118'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,

  Biomedical'
year: '2014'