Access ii Acknowledgements

First and foremost, I give thanks and praise to God for His limitless mercy and grace in lighting our paths. Always there for me also were my loving family, without whose love and support I would not succeed. I particularly want to thank Morris Atkinson and Alan Napier for planting the seed, which grew into this project, and for getting me headed in the right direction. Morris, thank you especially for compiling and converting these data into usable form. My sincere gratitude also goes to the clinic chiefs and their providers and staff for the candid input, and for allowing me the liberty of observing your operations. Thanks to Mary Ancker for the TriWest interface, and to Adan Lozano for information from the contractor. Willie Sauls has helped me to understand the appointing process, and how it has evolved. Dave Lopez also helped collect data. And thanks, Shawn Wagner, for your patience, listening, and ideas. There were countless others who contributed in some way to this effort, from clinicians and administrative staff, to peers and patients. Thanks to all for making this a truly rewarding and fruitful learning experience. Access in This study examines access to outpatient services at William Beaumont Army Medical Center for all beneficiary groups i