TIME COSTS OF OUTPATIENT VISITS: THE AMERICAN TIME USE SURVEY

   Purpose.  Time is a cost of care to patients and their unpaid caregivers, one that the Panel on Cost-Effectiveness in Health and Medicine recommended be included in cost-effectiveness analyses.  We present data from a new national survey on the time patients and their companions spend traveling, waiting, and receiving services during outpatient visits. 

   Methods.  The American Time Use Survey, a telephone survey conducted by the Census Bureau for the Bureau of Labor Statistics, asks a nationally representative sample of Americans 15 or older about their activities over a 24-hour period. Days are sampled continuously throughout the year.  During the first four survey years (2003-2006), 60,674 respondents were randomly selected from households that completed the Current Population Survey; 1,621 reported seeking outpatient care for themselves on their survey day. 

   Results.  In 2003-2006, 3.4% of persons 15 or older reported traveling and receiving outpatient services each day.  One-third reported waiting.  Mean time for those who reported each activity was 35 minutes traveling (95% CI, 33-37 minutes), 42 minutes waiting (37-47), and 74 minutes receiving services (70-79).  Mean total time per patient was 121 minutes (116-127). Total time was somewhat higher for men than women, but varied little by age.  Overall 39.5% of patients, and almost half of those aged 65 or older, were accompanied to their outpatient visits, some by more than one person.  Companions, 80% of whom were family members, spent a mean of 124 minutes per outpatient visit (112-135).

   Conclusions.  The American Time Use Survey shows that outpatient visits are time-intensive for patients and their families.  Patients and caregivers spend considerably more time than the face-to-face time with the physician reported annually by the National Ambulatory Medical Care Survey.  The American Time Use Survey provides the data analysts need to value the time costs of outpatient visits for cost and cost-effectiveness analyses.  It also provides a benchmark for research that explores the use of patients' and caregivers' time, in keeping with the IOM's recommendations in Crossing the Quality Chasm to respect patients' time and recognize the involvement of family and friends.