50 days to see a doctor in Boston…Is universal coverage the cause?

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50 days to see a doctor in Boston…Is Massachusetts’ universal coverage laws the cause?


From the USA Today, here are the wait times to see a doctor in the following cities:

    * Boston: 49.6
    * Philadelphia: 27
    * Los Angeles: 24.2
    * Houston: 23.4
    * Washington, D.C.: 22.6
    * San Diego 20.2
    * Minneapolis: 19.8
    * Dallas: 19.2
    * New York: 19.2
    * Denver: 15.4 days
    * Miami: 15.4 days

The first thing that jumps out from these numbers is that Boston has by far the longest wait to see a doctor.  Is this caused by the universal health coverage enacted in Massachusetts?  The answer is maybe.  Physician supply adjusts slowly (i.e., it takes a long time to finish med school).  On the other hand, Massachusetts decision to increase insurance coverage lead to a spike in the demand for medical services.  Thus, universal health care may have caused the run up in wait times, but this phenomenon may be short lived.  Physicians may migrate to Massachusetts as insurance coverage becomes more available. 

Do wait times reflect quality of care?  If Boston residents have very short waits to see nurse practitioners or physicians assistants, this could be a cost-effective substitute for services provided by physicians in the primary care setting.  Further, longer wait times for specialists could be a good thing.  While longer wait times would certainly hurt some patients–likely the most seriously ill patients–it would discourage other patients from waiting to see a specialist.  This patients could, instead, forego treatment if had a low marginal benefit to begin with or they could rely on their primary care provider. 

Let’s dig deeper into the numbers (see original report):

    * Wait times for Boston cardiologists decreased from 37 days in 2004 to 21 days in 2009. 
    * Wait times for Boston orthopedic surgery increased from 24 days in 2004 to 40 days in 2009. 
    * Wait times for a Boston ObGyn increased from 45 to 70 days between 2004 and 2009 in Boston.
    * Wait times for a Boston Family Practice physician was 63 days in 2009.

We see that after the Massachusetts health reform was enacted, there was no uniform effect on specialist wait times, but there was a large increase in wait times for primary care providers.  This could be explained by a number of phenomenon:

    * Those who gained health insurance after the Massachusetts health reform were a healthier population and used their new insurance coverage to increase the number of primary care visits, but not specialist visits.
    * After the Massachusetts health reform, the increase in demand was homogenous across primary and specialty care.  However, physician supply adjusted.  Specialist may have been more attracted to practicing in Massachusetts, but primary care doctors were not.  Specialists may have moved to Massachusetts in larger numbers, particularly if New England health plans reimburse specialists at a much higher rate. 
    * This could be a statistical anomaly.  Sample sizes in were less than 20 for five specialities in Boston.