Waiting Time Policies in the Health Sector

What Works?

image of Waiting Time Policies in the Health Sector

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.



A review of waiting times policies in 13 OECD countries

This chapter reviews various policy tools that countries have used to tackle excessive waiting times in 13 countries: Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom. The most common policy is some form of maximum waiting time guarantee. Increasingly, such guarantees are backed with targets set for providers and sanctions if these targets are not met. The guarantees often go hand-in-hand with choice, competition and an increase in supply (in the public and/or the private sector). These policies have generally been successful in bringing down waiting times. In contrast, most attempts to increase supply temporarily in order to decrease waiting times have had only a limited effect. A better approach may be to condition increases in supply on simultaneous reductions in waiting times. Demand-side policies attempt to define more rigorous clinical thresholds for treatment. However, it has proved difficult to implement such thresholds. The most promising approaches link waiting time guarantees to different categories of clinical need, also referred to as waiting time prioritisation. An alternative demand-side approach is to encourage private health insurance to shift demand from the public to the private sector, though this has generally not proven successful in reducing waiting times.




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