Wait times for health care appointments vary widely in the United States, ranging from same day service to several months, according to a report released today by the Institute of Medicine. Causes for delays include mismatched supply and demand, the current provider-focused approach to scheduling, outmoded workforce and care supply models, priority-based queues, care complexity, reimbursement complexity, and financial and geographic barriers, the study committee said. To help speed widespread progress toward timely appointments, the report recommends anchoring national initiatives to address scheduling and access issues to certain basic access principles: supply-demand matching through formal ongoing evaluation; immediate engagement and exploration of need at time of inquiry; patient preference on timing and nature of care invited at inquiry; need-tailored care with reliable, acceptable alternatives to clinician visit; surge contingencies in place to ensure timely accommodation of needs; and continuous assessment of changing circumstances in each care setting. The study was sponsored by the Department of Veterans Affairs.