Workers paying dearly for doctor wait times, other ambulatory ‘opportunity costs’

Time is money, and patients seeking ambulatory care waste too much of both. In fact, they spend more on “opportunity costs”—an average of $43 per visit—than on out-of-pocket payments for the ambulatory visit itself.

Kristin Ray, MD, of the University of Pittsburgh School of Medicine, and colleagues arrived at this finding by conducting a secondary analysis of the 2003-2010 American Time Use Survey (ATUS) put out by the Bureau of Labor Statistics.

Published in the American Journal of Managed Care, the analysis combines estimates of opportunity costs for working adults using self-reported hourly wages.

The authors used the Heckman correction/selection model to fold in figures for unemployed adults.

Opportunity costs, broadly defined, are those that accrue when people pursue one set of actions rather than some other they could have chosen instead. In the case of patients receiving ambulatory care, this mainly translates to time away from work and other daily duties while patients travel to, wait for and receive such care.

The authors found that the average total time per visit was 121 minutes (95 percent CI, 118-124), with 37 minutes (95 percent CI, 36-39) of travel time and 84 minutes (95 percent CI, 81-86) of clinic time.

Finding caregivers on the front end and paying bills on the back also contributed to driving up patients’ opportunity costs.

In the U.S., opportunity costs totaled an eye-popping $52 billion in 2010, the authors found.

Meanwhile, for every dollar spent by patients’ payers in visit reimbursement, patients racked up an additional 15 cents in opportunity costs.

Opportunity costs are increasingly relevant as U.S. healthcare demands patient-centered care, the authors point out.

Then too, there’s growing appreciation for the fact that not every physician visit calls for face-to-face care. With this recognition may come greater demand for innovations that can help ease time burdens, such as telemedicine.

“Our estimates, specifically among the employed, demonstrate the potential financial impact [of ambulatory visits] on worker productivity, which may have particular importance from the employer perspective,” the authors write.

The indirect healthcare cost just for employed adults is $25 billion in opportunity costs and 1.1 billion hours of time, according to Ray and colleagues, who add that this hourly tally is equivalent to the total annual hours worked by 563,000 fulltime employees—approximately the entire employed adult population of Dallas, Texas.

“Accounting for patient opportunity costs is important for examining U.S. healthcare system efficiency,” they conclude, “and for evaluating methods to improve the efficient delivery of patient-centered care.”