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.
Italy
In Italy, waiting time is a critical issue for out-patient specialist care and diagnostic services, and it is being tackled by national plans issued in the last decade. Most regions improved patients’ access through better information on waiting times, process re-engineering and the creation of unified booking centres. In addition, important prioritisation criteria have been piloted to manage waiting time based on clinical criteria and professional judgment (for example, the Homogenous Waiting Groups pilots). However, actual policies, including the implementation of national legislation, vary across the regions, with some of them very active and others often lagging behind. Policies on co-payments, intramoenia dual practice and voluntary insurance also have substantial effects on waiting time. National and regional co-payments have likely reduced waiting time via the reduction of demand for national health services, but rather broad exemption criteria have limited their effect on the more affluent and healthier part of the population. The expansion of intramoenia dual practice and the promotion of additional private health insurance could undermine access to the NHS basic health care package: the former may encourage doctors to build up long lists in their public practices so as to maintain demand for their private practice, whereas the latter may worsen equity of access to the NHS services.