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.
The Netherlands
In the Netherlands, hospital waiting times increased during the 1990s as a result of the introduction of fixed budgets and capacity constraints for specialists, complementing the fixed global hospital budgets already introduced in the 1980s. Though the resulting waiting lists were still small compared to other OECD countries, public discontent initiated government action. Over the years 2000-11 policies included a change from fixed budgets to activity-based funding, for both hospitals and specialists, and increased competition among hospitals. All together these measures resulted in a strong reduction of waiting times. In 2011, mean expected waiting times for almost all surgical procedures were below five weeks, which is well under the generally agreed norm of 6-7 weeks. Waiting lists are thus no longer an important policy concern. Dutch policy makers are now primarily concerned about the rapid growth in health care expenditure as a result of a combination of hospitals’ and specialists’ incentives for extra production and insurers’ limited countervailing power. Hence, new powerful supply-side constraints are being introduced in 2012. These constraints may cause waiting times to increase in the coming years, especially for more complex surgical procedures that are subject to price regulations.