Patients may need to wait for health
services for a number of reasons, including a lack of medical equipment or no available
hospital beds, short-staffing, or inefficiencies in the organisation of services.
Excessive waiting times to see a doctor or for non-emergency surgery can sometimes lead to
adverse health effects such as stress, anxiety or pain (Sanmartin, 2003). Dissatisfaction
and strained patient-doctor relationships also damage public perceptions of the health
Since most countries use their own
definitions, collecting comparable data on waiting times is difficult. Multi-country
patient surveys are useful, although these rely on self-report, have limited sample size
and may not be consistent with administrative data.
These surveys find that waiting times
vary substantially. While in some countries they are a major health policy concern, others
report no significant waiting times at all. Waiting times to see a primary care physician
or nurse in 2010 were low in most of the 11 countries covered by the Commonwealth Fund
Survey, and only in Canada, Norway and Sweden did a significant number of patients have to
wait for six days or more (Davis et al., 2010).
Waiting times for specialist
consultations were also higher in Canada, Norway and Sweden, with 50% or more of survey
respondents waiting at least 4 weeks for an appointment (Figure 6.8.1). In Germany, Switzerland and the United States, more timely
access was provided. Waiting times for elective surgeries such as cataract removal or hip
replacement also show substantial differences. In 2010, a considerable proportion of
patients in Canada, Sweden, Norway, the United Kingdom and Australia reported waiting four
months or more for elective surgery (Figure 6.8.2) (Davis et al., 2004, 2006, 2010; Schoen et al., 2010).
Waiting times can vary within
countries. Though very moderate waiting times for a doctor consultation are reported for
Germany, patients in the eastern part of the country report waiting longer (KBV, 2010).
There is evidence from several countries, including England, Germany and Austria, that
persons in higher socio-economic groups or with private health insurance have shorter
waiting times (Laudicella et al., 2010; KBV, 2010;
Statistik Austria, 2007). In Canada, women have longer waiting times for specialist
consultations than men, possibly because men consult a specialist at a more advanced or
acute stage of disease, and have a more urgent need for treatment (Carrière and Sanmartin,
Initiatives to cut waiting times have
been launched in a number of OECD countries. In England, the government set a target
in 2000 of a maximum 18 weeks from referral to treatment for elective care, and by 2008,
94% of admitted patients and 98% of non-admitted patients were treated within that time
(Department of Health, 2009). These administrative data show more positive results than
those reported in surveys (Figure 6.8.2). In New Zealand, waiting times
for elective surgery were also addressed as a major health target and have decreased
since 2005, while the access and level of services have improved substantially (MoH,
In Canada, waiting times for a set of
priority areas, including hip and knee replacement and cataract surgery, were targeted
in 2004 as part of the 10-Year Plan to Strengthen Health Care. The most recent assessment
for 2010-11 reported eight out of ten patients receiving priority procedures within
benchmarks. For hip replacement, seven out of ten provinces treated 75% of patients within
26 weeks, while the benchmark for cataract surgery (75% of patients treated within
16 weeks) was met in six provinces (CIHI, 2011).
Optimum waiting times are not
necessarily zero. It can be cost-effective to maintain short queues of elective patients
because the adverse health consequences of short delays are minimal, and there are savings
in hospital capacity from allowing queues to form (Siciliani and Hurst, 2003). They may
also deter patients who stand to gain only small health benefits from demanding treatment
(Laudicella et al., 2010).
Definition and comparability
In the Commonwealth Fund Surveys,
waiting times for doctor or nurse consultations refer to the days or weeks the patient
had to wait to get an appointment when sick, or in need of medical attention. Waiting
times for specialist and elective surgery was the time between the patient being
advised that they needed care and the appointment. Only those respondents who had
specialist consultations or elective surgery in the last year or two were asked to
specify waiting times.
Since there are no universally
accepted definitions of waiting times, data derived from different sources may not be
|Indicator in PDF
|6.8.1 Waiting time of four weeks or more for a specialist
|6.8.2 Waiting time of four months or more for elective