Extended office hours and health care expenditures: a national study.

摘要

A key component of primary care improvement efforts is timely access to care; however, little is known regarding the effects of extended (evening and weekend) office hours on health care use and outcomes. We examined the association between reported access to extended office hours and both health care expenditures and mortality.We analyzed data from individuals aged 18 to 90 years responding to the 2000-2008 Medical Expenditure Panel Surveys reporting access or no access to extended hours via a usual source of care in 2 successive years (year 1 and year 2; N = 30,714). Dependent variables were year 2 total health care expenditures and, for those enrolled in 2000-2005, all-cause mortality through 2006. Covariates were year 1 sociodemographics and health care use, and year 2 health insurance, health status, and chronic conditions. We conducted further analyses, progressively adjusting for year 2 use, to explore mechanisms.Total expenditures were 10.4% lower (95% confidence interval, 7.2%-13.4%) among patients reporting access to extended hours in both years vs neither year. Adjustment for year 2 prescription drug expenditures, and to a lesser extent, office visit-related expenditures (but not total prescriptions or office visits, or emergency and inpatient expenditures) attenuated this relationship. Extended-hours access was not statistically associated with mortality.Respondents reporting a usual source of care offering evening and weekend office hours had lower total health care expenditures than those without extended-hours access, an association related to lower prescription drug and office visit-related (eg, testing) expenditures, without adverse effects on mortality. Although requiring further study, extended office hours may be associated with more judicious use of health care resources.