2. How long are waiting times across countries?
The definition and measurement of waiting times varies significantly across OECD countries, limiting the comparability of data. For non-emergency care, the measurement can use different start and end points. As shown in Figure 1.1 in Box 1.1, the waiting time can be recorded from the GP referral or following a specialist visit. It can end with a surgery or medical treatment, or with a specialist visit. Some health systems will measure what is sometimes referred to as the “outpatient” waiting time (from GP referral to specialist visit), others the “inpatient” waiting time (from a specialist decision to add the patient on the list to treatment), yet others measure the full referral-to-treatment waiting time (from GP referral to treatment), as is the case in Denmark, Norway and England.
For any health services, it is possible to measure and report the mean waiting time, the median waiting time or the waiting time at other percentiles of the distribution, and the number or proportion of patients waiting more than a threshold waiting time (for example 3, 6 or 12 months). The distribution of waiting times is generally skewed, with a small proportion of patients waiting a very long time. Hence, the mean waiting times can be substantially longer than the median.
Information on waiting times can be collected through administrative databases or surveys. One advantage of surveys is that they can often readily be used to measure any inequalities in waiting times across socio-economic groups, but one downside is that the data may be less reliable particularly if the sample size is small and may also become outdated if the surveys are not conducted regularly.
Annex A describes in more detail good practices in some countries in setting information systems to measure waiting times.
2.1. Waiting times for GP and specialist consultations vary more than two-fold across countries
According to the 2016 Commonwealth Fund International Health Policy Survey conducted in 11 OECD countries (Box 2.1), most people in 2016 were able get an answer to their medical concern from their regular doctor’s office on the day when they contacted the office, although in some countries it was easier to get such a quick answer (Figure 2.1). The share of people reporting that they “sometimes, rarely or never get an answer from their regular doctor’s office on the same day” was low in Switzerland (12%), Germany (13%) and the Netherlands (13%), but higher in Canada (33%) and the United States (28%). In most countries, this share did not change significantly between 2013 and 2016, although the survey results show progress in Australia and Switzerland, and suggest some deterioration in Sweden.
Over the past 20 years, the Commonwealth Fund has coordinated the use of a household health survey across a number of OECD countries to collect a wide range of information, including on waiting times for GP consultations, specialist consultations and elective surgery. The number of OECD countries participating in this International Health Policy Survey has increased from five initially to eleven for the last wave in 2016 (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and United States). While the sample size in some countries is fairly small, some countries have decided to increase the sample size to improve data reliability (e.g. there were over 5 000 respondents in Australia, over 4500 respondents in Canada and over 7 000 respondents in Sweden for the last wave in 2016).
Note: 95% confidence intervals are shown by H.
Source: OECD calculations based on 2013 and 2016 Commonwealth Fund International Health Policy Surveys.
Turning to specialist care, waiting times for a specialist appointment also vary significantly across countries participating in the Commonwealth Fund survey (Figure 2.2). In 2016, the difference across countries was more than two-fold: over 60% of people waited one month or more for a specialist appointment in Canada and Norway, compared with about 25% only in Switzerland, Germany and the Netherlands. In many countries, waiting times for a specialist appointment has remained fairly stable between 2010 and 2016, although the survey results suggest that the situation has worsen in Norway, the United Kingdom and the United States.
Note: 95% confidence intervals are shown by H.
Source: OECD calculations based on 2013 and 2016 Commonwealth Fund International Health Policy Surveys.
2.2. Waiting times for elective surgery is nearly ten-fold higher in some countries
Results from the regular OECD data collection on waiting times for common elective surgery show that they vary even more across the group of 17 OECD countries that report these data (which are based mainly on administrative sources). On average across these OECD countries, the median waiting times for more minor surgery like cataract operation was 95 days in 2018, and longer for more major surgery like hip replacement (110 days) and knee replacement (140 days). However, there are huge variations across countries. In general, waiting times for elective surgery in 2018 were the lowest in Denmark, the Netherlands, Italy and Hungary (where reducing waiting times for elective surgery is a key goal under the 2014-2020 Health Sector Strategy), while they were the highest in Estonia, Poland and Chile.
Looking at specific surgical procedures, Figure 2.3 shows that:
The median waiting times for a cataract surgery varied from less than 40 days in Italy, Denmark and Hungary, to over 180 days (6 months) in Estonia and 250 days (over 8 months) in Poland.
The median waiting times for a hip replacement was about 50 days or less in Denmark, Hungary, Italy and the Netherlands, compared with 240 days (about 8 months) or more in Estonia and Chile.
The median waiting times for a knee replacement ranged from about 50 days or less in Italy, Denmark and the Netherlands, to 460 days (about 15 months) in Estonia and 840 days (about 28 months) in Chile.
Among the group of countries that have very long waiting times, the median waiting times for cataract surgery in Estonia decreased sharply between 2008 and 2013 (from over 300 days to 100 days), but then increased to reach more than 180 days in 2018. Recent trends in waiting times for hip replacement and knee replacement are even worse, with waiting times increasing greatly to levels exceeding those of ten years ago. In Chile, the median waiting times for hip replacement remained stable at around 240 days between 2013 and 2018. With regards to knee replacement, waiting times decreased from about 1 150 days (more than 3 years) in 2013 to 840 days (2 years and 4 months), but is still by far the longest. In Poland, the median waiting times fell sharply between 2013 and 2018 for cataract surgery and hip replacement, but still remain relatively high.
Among the group of countries that have relatively short waiting times now, Italy and the Netherlands have managed to keep waiting times for elective surgery relatively short in recent years (despite tight budgetary constraints in the case of Italy), while Denmark and Hungary have managed to reduce waiting times through a combination of policy actions (see Section 4).
Note: † For the Netherlands, the data on waiting times is the mean number of days because the median is not available (resulting in an over-estimation compared with other countries). * For Norway, waiting times are over-estimated because they start from the date when a doctor refers a patient for specialist assessment up to the treatment (whereas in other countries they start only when a specialist has assessed the patient and decided to add the person on the waiting list for treatment).
Source: OECD Health Statistics.
In all countries, patients requiring more urgent treatments generally wait less than those whose health status is less likely to deteriorate while waiting. Prioritisation arises not only for people requiring the same treatment, but also across treatments (Gravelle and Siciliani, 2008[6]), as reflected for example by the fact that cancer patients wait significantly less than patients requiring a hip replacement. For instance, median waiting times for coronary bypass, hysterectomy and prostatectomy are generally shorter than for hip and knee replacement (Table 2.1).
When looking at the people who are still on the waiting lists and have not been treated yet, there are also large variations in the percentage of patients who have been waiting for over three months across the 12 countries that report these data. This proportion is lower in Hungary, New Zealand, Sweden and Spain for cataract surgery, and much higher in Slovenia, Estonia, Poland and Ireland (Figure 2.4).
In Slovenia, Poland and Estonia, the vast majority of patients (over 80%) on the waiting list for a cataract surgery or a hip or knee replacement has been waiting more than three months. This figure has been fairly stable in Poland and Estonia over the past 10 years. By contrast, in Sweden and New Zealand less than 25% of patients wait longer than three months, with this proportion coming down considerably in New Zealand since 2008.
Source: OECD Health Statistics.
