Improving Access to Healthcare: Models of Adaptive Behavior

Demand for healthcare is increasing due to a growing and aging population, making access to care more difficult. Beyond anecdotal evidence, there is increasing empirical evidence of access problems, most notably through overcrowding in emergency departments (EDs) (Burt and Schappert 2004; Committee on the Future of Emergency Care in the United States 2007). While demand is increasing, the supply of hospital beds, physicians, nurses, and other health resources remains relatively stagnant or, worse, is potentially decreasing. It is already the case that the supply of nurses is insufficient to meet demands (Chagaturu and Vallabhaneni 2005), and there are predictions of severe physician shortages in the coming years (Cooper et al. 2002; Merritt et al. 2004; Salsberg and Forte 2002). As a consequence of high demand and insufficient supply, many patients experience delays in receiving treatment. The overall median wait to see an ED physician increased from 22 min in 1997 to 30 min by 2004. Perhaps even more alarmingly, the median wait for patients diagnosed with acute myocardial infarction (AMI) (heart attacks) increased from 8 min in 1997 to 14 min in 2004 (Wilper et al. 2008). In one study of patients and their primary care physicians, 33% of patients cited inability to get an appointment soon as a significant obstacle to care (Strunk and Cunningham 2002). The average wait for a primary care appointment in the US in 2001 was over 3 weeks (Murray and Berwick 2003). Sixty percent of physicians reported being dissatisfied with delays (Poon et al. 2004).