NPR had an interesting piece about state regulations in California for timely access to health care services (“New Calif. Rules Cut Wait Times For Medical Care”).
Under new state regulations that will take effect this fall, appointments for a non urgent primary-care visit must be made available within 10 business days; a non urgent appointment with a specialist, within 15 business days; and most urgent-care appointments must be available within two days. The rules say that all after-hour emergency calls to a doctor must be returned within 10 minutes. The new regulations apply only to patients in managed health care plans, or about 19 million Californians, but it’s expected that all doctors in the state will adopt the wait-time limits.
It is probably one of the first cases in which the government regulates waiting times in such a specific and clearly defined manner. The 2002 Timely Access Law required health care providers to respond in a timely manner to patient needs, but was not very specific on what “timely” means. Several states (such as Vermont) have Consumer Bill of Rights which state that service providers (for example, telephone services) are required to respond in a timely manner to customers’ requests. However, I am not aware of such specific rules regarding waiting times, set by regulators.
The interesting thing here is fact that the rules are not only clearly-defined but that they are fairly strict. For example, the fact that off-hours emergency patients need to get a response within 10 minutes. Since these system are subject to quite a bit of variability, one can imagine cases in which all agents (nurses and physicians) will be occupied handling prior calls/cases. Should they still respond even if it means dropping the other calls? In call centers we usually tend to see that quality-of-service is defined as “80% of the calls are answered within 20 seconds” (or something along these lines). What is the reasonable percentage? I am not sure.
The main idea of this law was initially to make sure HMO’s provide adequate service with the resources they have. However, it seems that nowadays the main factor hindering timely response is the lack of resources, and not an inefficient use of the available resources:
Ginsburg and other experts say they agree today’s wait times are, in large part, due to low reimbursement rates for primary-care doctors and the nationwide shortage of primary-care physicians. Specialists are also in short supply in many areas.
I am curious to see how the quality of service (in terms of response time as well as quality of care) will be impacted by this new law, in managed health care plans (which will be regulated by the new law) as well as other plans.