Racial disparities in access to specialty care may have persisted across both Veterans Health Administration and community care settings, with Black veterans consistently experiencing the longest wait times, according to a nationwide analysis.

In the study, investigators examined more than 10 million specialty care referrals for nearly 4.4 million patients between 2018 and 2022. They analyzed over 6.6 million referrals within the Veterans Health Administration (VHA) and almost 3.8 million community-based specialists across 10 high-volume specialties: cardiology, dermatology, gastroenterology, ophthalmology, orthopedics, otorhinolaryngology, podiatry, urology, physical therapy, and mental health.

Black veterans had the longest mean wait times for VHA specialty appointments at 40.0 days, followed by American Indian/Alaska Native veterans at 38.6 days, Hispanic veterans at 38.4 days, Asian/Pacific Islander veterans at 38.1 days, and White veterans at 37.1 days. In community care, average wait times were even longer—52.9 days for Black veterans, 46.8 days for Asian/Pacific Islander veterans, 46.5 days for American Indian/Alaska Native veterans, 45.1 days for White veterans, and 42.0 days for Hispanic veterans. Across all groups, more than 50% of referrals exceeded the VHA’s 28-day access standard.

Using multivariate regression and Kitagawa-Oaxaca-Blinder decomposition, the investigators found that differences in the referring facility accounted for the majority of racial disparities. Compared with White patients, Black veterans waited an average of 2.5 and 5.5 days longer for VHA specialty and community care appointments, respectively, as a result of facility-level differences. Specialty mix, comorbidity burden, and patient age had smaller effects.

“Policies designed to increase quality and health care supply in under-resourced areas may be an important strategy in closing racial inequities in timely access to care,” wrote lead study author Daniel A. Asfaw, PhD, of the Department of Health Law, Policy, and Management at the Boston University School of Public Health and the Partnered Evidence-Based Policy Research Center at the VA Boston Healthcare System, and colleagues.

Source: Health Services Research