Waiting Time Policies in the Health Sector
What Works?
Over the past decade, many OECD countries have introduced new policies to tackle excessive waiting times for elective surgery with some success. However, in the wake of the recent economic downturn and severe pressures on public budgets, waiting times times may rise again, and it is important to understand which policies work. In addition, the European Union has introduced new regulations to allow patients to seek care in other member states, if there are long delays in treatment. This book provides a framework to understand why there are waiting lists for elective surgery in some OECD countries and not in others. It also describes how waiting times are measured in OECD countries, which differ widely, and makes recommendations for best practice. Finally, it reviews different policy approaches to tackling excessive waiting times. Some countries have introduced guarantees to patients that they will not wait too long for treatment. These policies work only if they are accompanied by sanctions on health providers to ensure the guarantee is met or if they allow greater choice of health-care providers including the private sector. Many countries have also introduced policies to expand supply of surgical services, but these policies have generally not succeeded in the long-term in bringing down waiting times. Given the increasing demand for elective surgery, some countries have experimented with policies to improve priorisation of who is entitled to elective surgery. These policies are promising, but difficult to implement.
Ireland
Long waiting times to access health services have characterised the Irish health sector from the early 1990s. These waiting times may in part arise from the complex interaction of public and private finance and delivery that is characteristic of the Irish health services. The major policy initiatives implemented to reduce waiting times have been in the form of additional dedicated funding. Maximum waiting time targets were also introduced, but these were not accompanied by penalties for non-fulfilment. While the first major policy initiative – the Waiting List Initiative – granted additional funding to public hospitals, its successor – the National Treatment Purchase Fund – instead channelled funding predominantly to private hospitals. Recently, a new Special Delivery Unit has been established in order to reduce waiting times for scheduled and unscheduled care in Irish hospitals by adopting an approach based on performance management and capacity building.