Waiting Time Policies in the Health Sector

What Works?

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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 National Health Care Guarantee was introduced into Finnish law in 2005. The guarantee defines maximum waiting times for hospital and primary care services, including dental care. To support the guarantee, uniform grounds for access to non-emergency care were introduced.After the establishment of the guarantee, waiting times for hospital care have become shorter, although the development has been bumpy and characterised by a rubber band phenomenon. The Supervisory Agency has given several hospital districts that failed to comply with the guarantee orders to improve, often accompanied by the threat of penalty fines. Consequently, waiting times have shortened considerably, but the situation deteriorated again when the threat of fines was removed. Regional variations in accessibility still exist.Research is limited as to the broader range of consequences of the guarantee, e.g. whether resources have been allocated from chronic patient groups in need of repeated hospital care to patients to be admitted for the first time. The economic consequences of the reform have not been calculated in detail.The observed reductions in waiting times may partly be explained by other parallel trends in the health sector, e.g. increased diversity in the production of services and increasing freedom of choice.




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