Ok, a bunch of folks — Globe, Newsweek, USA Today, Cato, Heartland Institute — have picked up a Merritt Hawkins survey of physician waittimes. And more specifically, that wait times in Massachusetts have increased over the past five years — which at least some observers ascribe to the impact of healthcare reform here.
That’s all well and good, until it shows up on one of my favorite sites — Adam Gaffin’s Universal Hub. Then I need to step in.
There are a couple of problems with the report —
1) Sample size — To get data from Boston, they called between 9 and 18 doctors in each specialty in both 2004 and 2009. (And not the same doctor’s each time.) That’s a really, really small sample size (tinker with this calculator and you come up with margins of error in the +/- 20 percent range or the finding that you need 5 – 10X more samples).
2) Vagaries of Medical Scheduling — As a fairly heavy user of medical care, I’ve called doctors for appointments in various circumstances — referral versus non-referred, claiming sickness versus not, etc. I’ve found that there is huge variations in how I’m handled — one particularly diplomatic discussion with a scheduler moved my appointment up by nine months. This report has them cold-calling offices, apparently from the Yellow Pages, and asking for appointments for routine exams, not existing conditions or medical emergencies. How many people cold-call a cardiologist for a routine exam?
3) Read the report findings. The report looks at increased waiting times across four physician categories. Two show increased waiting times. One shows decreased waiting times. One was not measured in 2004, so a comparison cannot be made. This is hardly an overwhelming finding.
Ok, so those are the shortcomings of the report. As for the shortcomings of the conclusion that this is caused by healthcare reform, I’d point out that the report covers 2004 to 2008-2009. Healthcare reform was enacted roughly in the mid-point of this period, so you can’t be sure its the sole casual factor in changes in wait times.
Now, the original thought might be right — it is possible, and seems logical, to assume that the supply of healthcare (in the form of doctor’s appointments) would take a long time to respond to the influx of newly insured and this inbalance would take the form of longer wait times for doctors’ appointments.
But you can’t draw that conclusion from this study.