Extended Office Hours and Health Care Expenditures: A National Study

Anthony Jerant; Klea D. Bertakis; Joshua J. Fenton; Peter Franks

doi:10.1370/afm.1382

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Table 1

Respondent Characteristics by Reported Extended-Hours Access

	Access to Extended Hours^a
Characteristic	No (n=21,817)	Yes (n=11,452)	Total (N=33,269)
Year 1 characteristics
Female, % (SE)	57.6 (0.3)	55.9 (0.4)	57.0 (0.3)
Age, mean (SE), y	51.8 (0.2)	45.7 (0.2)	49.7 (0.2)
Race/ethnicity, % (SE)
White	77.1 (0.7)	76.1 (0.9)	76.8 (0.6)
Hispanic	8.5 (0.5)	8.6 (0.5)	8.5 (0.4)
Black	9.7 (0.5)	9.6 (0.5)	9.7 (0.4)
Other	4.7 (0.3)	5.7 (0.4)	5.0 (0.3)
Family income, % (SE) of FPL
<100%	9.7 (0.3)	7.2 (0.3)	8.8 (0.3)
100% to <125%	4.1 (0.2)	2.8 (0.2)	3.6 (0.1)
125% to <200%	12.9 (0.4)	10.3 (0.4)	11.9 (0.3)
200% to <400%	30.5 (0.4)	31.8 (0.7)	31.0 (0.4)
≥400%	42.9 (0.6)	47.9 (0.9)	44.7 (0.6)
Education, % (SE)
Less than high school	6.7 (0.3)	4.4 (0.2)	5.9 (0.2)
Some high school	11.1 (0.3)	10.5 (0.4)	10.9 (0.2)
High school graduate	32.2 (0.5)	33.8 (0.6)	32.8 (0.4)
Some college	23.1 (0.4)	24.1 (0.5)	23.4 (0.3)
College graduate	26.9 (0.6)	27.3 (0.7)	27.0 (0.5)
Urban residence, % (SE)	76.0 (1.2)	86.3 (0.9)	79.7 (0.9)
US Census region, % (SE)
Northeast	14.8 (0.9)	29.0 (1.6)	19.9 (0.9)
Midwest	20.6 (1.0)	27.6 (1.4)	23.1 (0.9)
South	43.8 (1.3)	22.8 (1.3)	36.3 (1.1)
West	20.8 (1.3)	20.6 (1.3)	20.8 (1.1)
Year 2 characteristics
Health insurance, % (SE)
Private	75.9 (0.5)	81.5 (0.6)	77.9 (0.4)
Public	17.7 (0.4)	11.7 (0.5)	15.6 (0.4)
None	6.4 (0.2)	6.8 (0.3)	6.6 (0.2)
Health conditions, mean (SE), No.^b	1.2 (0.0)	0.8 (0.0)	1.1 (0.0)
PCS-12 score, mean (SE)^c	47.0 (0.1)	49.8 (0.1)	48.0 (0.1)
MCS-12 score, mean (SE)^c	50.7 (0.1)	51.4 (0.1)	50.9 (0.1)
Self-rated health, % (SE)
Excellent	19.2 (0.4)	22.5 (0.6)	20.4 (0.4)
Very good	33.6 (0.5)	37.4 (0.7)	34.9 (0.4)
Good	30.3 (0.4)	28.6 (0.6)	29.7 (0.3)
Fair	12.2 (0.3)	8.8 (0.3)	11.0 (0.3)
Poor	4.7 (0.2)	2.7 (0.2)	4.0 (0.1)
Smoker, % (SE)	17.3 (0.3)	18.7 (0.5)	17.8 (0.3)
Body mass index in kg/m², % (SE)
<20	4.9 (0.2)	4.6 (0.2)	4.8 (0.1)
20 to <25	29.8 (0.4)	30.7 (0.6)	30.1 (0.3)
25 to <30	35.8 (0.4)	36.3 (0.5)	35.9 (0.3)
≥30	29.5 (0.5)	28.4 (0.6)	29.1 (0.4)

FPL = federal poverty level; MCS-12 = the 12-Item Short Form Health Survey (SF-12) Mental Component Summary; PCS-12 = SF-12 Physical Component Summary.
Note: Percentages are population weighted.
↵a No group = 64.2% (SE 0.8); Yes group = 35.8% (SE 0.8).
↵b From a count of 8 conditions: diabetes, hypertension, coronary heart disease, myocardial infarction, cerebrovascular disease, asthma, emphysema, and arthritis.
↵c Scores range from 0 to 100, with higher scores indicating better health.

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Table 2

Respondent Health Care Use and Expenditures by Reported Extended-Hours Access

	Access to Extended Hours^a
Measure	No (n=21,817)	Yes (n=11,452)	Total (N=33,269)
Office visits
Year 1
Number, mean (SE)	5.3 (0.1)	4.3 (0.1)	4.9 (0.1)
Expenditures, mean (SE), $	1,261.0 (23.9)	973.9 (31.5)	1,158.8 (20.1)
Year 2
Number, mean (SE)	5.4 (0.1)	4.2 (0.1)	5.0 (0.1)
Expenditures, mean (SE), $	1,229.4 (34.1)	947.4 (39.4)	1,129.0 (28.2)
Prescription medications
Year 1
Number, mean (SE)	19.6 (0.3)	13.2 (0.3)	17.4 (0.2)
Expenditures, mean (SE) $	1,283.4 (22.7)	833.6 (21.3)	1,123.4 (17.5)
Year 2
Number, mean (SE)	19.3 (0.3)	13.1 (0.3)	17.1 (0.2)
Expenditures, mean (SE), $	1,307.5 (22.0)	894.2 (31.2)	1,160.5 (19.4)
Emergency department visits
Year 1
Having any, % (SE)	15.5 (0.3)	13.6 (0.4)	14.8 (0.3)
Expenditures, mean (SE), $	142.7 (5.0)	122.5 (7.4)	135.5 (4.3)
Year 2
Having any, % (SE)	16.0 (0.3)	13.1 (0.4)	14.9 (0.3)
Expenditures, mean (SE), $	144.0 (6.0)	123.3 (10.6)	136.6 (5.2)
Hospitalizations
Year 1
Having any, % (SE)	11.0 (0.3)	8.2 (0.3)	10.0 (0.2)
Expenditures, mean (SE), $	1,391.0 (55.0)	1,038.9 (133.6)	1,265.7 (59.4)
Year 2
Having any, % (SE)	11.9 (0.3)	8.7 (0.3)	10.7 (0.2)
Expenditures, mean (SE), $	1,746.9 (66.8)	1,203.4 (116.2)	1,553.6 (57.9)
Total expenditures
Year 1, mean (SE), $	5,173.7 (87.7)	3,852.4 (157.0)	4,703.6 (82.5)
Year 2, mean (SE), $	5,522.3 (99.5)	4,067.1 (171.0)	5,004.6 (90.6)

Note: Percentages are population weighted.
↵a No group = 64.2% (SE 0.8); Yes group = 35.8% (SE 0.8).

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Table 3

Adjusted Associations Between Sample Characteristics and Logarithm of Year 2 Total Health Care Expenditures (N=30,714)

Characteristic^a	Adjusted Parameter Estimate (95% CI)	P Value
Access to extended hours in both year 1 and year 2 (reference = no access in both years)	−0.11 (−0.14 to −0.07)	<.01
Age, y	0.02 (0.01 to 0.02)	<.01
Female	0.19 (0.16 to 0.22)	<.01
Race/ethnicity (reference=white)
Hispanic	−0.22 (−0.28 to −0.16)	<.01
Black	−0.22 (−0.28 to −0.16)	<.01
Other	−0.20 (−0.29 to −0.12)	<.01
Income, % of FPL (reference = <100%)
100% to <125%	−0.06 (−0.15 to 0.03)	.20
125% to <200%	0.00 (−0.07 to 0.06)	.98
200% to <400%	0.04 (−0.03 to 0.10)	.24
≥400%	0.16 (0.09 to 0.22)	<.01
Education (reference = no high school)
Some high school	0.08 (−0.00 to 0.16)	.05
High school graduate	0.15 (0.09 to 0.22)	<.01
Some college	0.23 (0.16 to 0.30)	<.01
College graduate	0.33 (0.26 to 0.40)	<.01
Urban residence	0.06 (0.02 to 0.11)	<.01
US Census region (reference = Northeast)
Midwest	0.08 (0.02 to 0.13)	.01
South	−0.03 (−0.08 to 0.03)	.34
West	−0.01 (−0.06 to 0.05)	.80
Health insurance (reference = private), year 2
Public	−0.12 (−0.17 to −0.06)	<.01
None	−0.51 (−0.58 to −0.43)	<.01
Count of chronic health conditions, year 2	0.09 (0.07 to 0.10)	<.01
Health status, year 2
PCS-12 score	−0.02 (−0.02 to −0.02)	<.01
MCS-12 score	−0.01 (−0.01 to 0.00)	<.01
Self-rated health, year 2 (reference = excellent)
Very good	0.20 (0.15 to 0.25)	<.01
Good	0.31 (0.25 to 0.37)	<.01
Fair	0.36 (0.28 to 0.44)	<.01
Poor	0.57 (0.45 to 0.68)	<.01
Health care use
Total health care expenditures, per $1,000 increase	0.01 (0.01 to 0.01)	<.01
Any hospitalization (reference = none)	−0.05 (−0.11 to 0.00)	.06
Any emergency department visit (reference=none)	0.15 (0.11 to 0.19)	<.01
Office visits, number	0.03 (0.03 to 0.03)	<.01
Prescription medications, number	0.01 (0.01 to 0.01)	<.01

FPL = federal poverty level; MCS-12 = the 12-Item Short Form Health Survey (SF-12) Mental Component Summary; PCS-12 = SF-12 Physical Component Summary.
Note: Analyses also adjusted for Medical Expenditures Panel Survey panel year.
↵a Characteristics measured in year 1 unless noted.

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Table 4

Adjusted Percentage Change in Year 2 Total Health Care Expenditures Associated With Extended-Hours Access With Progressive Adjustment for Year 2 Health Care Use

Analysis	Adjusted % Change in Year 2 Total Health Care Expenditures (95% CI)	P Value
Base model	−10.4 (−13.4 to −7.2)	<.01
Model with progressive adjustment for year 2:
Emergency department and inpatient expenditures	−9.1 (−11.8 to −6.3)	<.01
+ Numbers of office visits and prescription medications	−8.4 (−11.0 to −5.8)	<.01
+ Prescription medication expenditures	−5.7 (−8.1 to −3.3)	<.01
+ Office visit expenditures	−4.3 (−6.5 to −2.0)	<.01

Note: All analyses adjusted for year 1 age, sex, race/ethnicity (white [reference], Hispanic, black, other), income (≤100% [reference], 100% to <125%, 125% to <200%, 200% to <400%, or ≥400% of federal poverty level), education (no high school [reference], some high school, high school graduate, some college, college graduate), Metropolitan Statistical Area, Census region (Northeast [reference], Midwest, South, West), health insurance (private [reference], public, none), total health care expenditures, hospitalizations (any vs none), emergency department visits (any vs none), number of office visits, and number of prescription medications; year 2 count of 8 chronic health conditions, the 12-Item Short Form Health Survey (SF-12) Mental Component Summary and Physical Component Summary scores, and self-rated health; and Medical Expenditures Panel Survey panel year.

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The Article in Brief

Anthony Jerant , and colleagues

Background Timely access to care could allow earlier diagnosis and treatment of health conditions and reduce health care expenditures. This study examines the relationship between access to extended (evening and weekend) office hours and health care utilization, outcomes, and expenditures, as well as mortality.

What This Study Found Patients who have access to a regular source of health care that offers evening and weekend hours have significantly lower health expenditures than those who do not. In this study, total expenditures were 10 percent lower among patients reporting access to extended hours compared to those lacking such access, an association related to lower prescription drug and expenditures related to office visits (such as testing). The reduced expenditures do not have apparent adverse effects on mortality.

Implications

Extended office hours may be associated with relatively judicious use of primary health care resources, including more generic medication prescribing and less discretionary testing.