A medical appointment may last twenty minutes.
Receiving it can take half a day.
First comes the search for an available provider. Then the call, the hold music, and the scheduling.
On the day of the appointment, there is the drive, the parking lot, the waiting room, the visit, and sometimes another stop at the pharmacy or lab.
The clinical part may be the shortest part of the entire experience.
Healthcare has a price measured in dollars.
It also has a price measured in time.
That second price does not appear on a claim or an explanation of benefits. It may show up as lost wages, used paid time off, a disrupted shift, or work that has to be finished later.
For someone paid by the hour, an appointment may mean earning less that week.
For someone on salary, it may mean catching up after everyone else has gone home.
For a teacher, driver, construction worker, or anyone whose job cannot simply pause, it may mean delaying care until the schedule becomes easier.
Sometimes the schedule never becomes easier.
Time can begin to behave like another form of cost sharing. The more of it healthcare requires, the harder the decision to seek care becomes.
Employers often discuss healthcare and productivity as separate issues.
The employee experiences them on the same afternoon.
The health plan may technically provide access. The employer may have a generous time off policy. The provider may have an appointment available.
Still, the employee has to make all three pieces work together.
Adding more appointments does not necessarily solve this problem if every appointment requires the same drive, the same waiting room, and the same interruption to the day.
Virtual care can remove some of that burden. But if the conversation ends by sending the employee back into the same process for an exam, testing, or follow up, only part of the time has been returned.
This is why we keep thinking about access as something larger than an appointment.
Care may need to begin through text, phone, or video. It may need to continue in person at home or work. It may require testing, medication, or another conversation a few days later.
The channel should be able to change without forcing the patient to start over.
The goal is not to make every interaction virtual or every visit happen at home.
It is to require no more of someone’s day than their health concern actually demands.
Healthcare will always take some amount of time. People need to speak with clinicians, receive examinations, and follow through on care.
But we should be more honest about how much extra time the system asks people to contribute.
A benefit is not fully accessible simply because the card says the service is covered.
It becomes accessible when the person can actually use it without turning healthcare into the main event of the day.
THE 60%
Field Notes from the Working Majority
FIELD NOTE NO. 008
THE HIDDEN PRICE OF AN APPOINTMENT