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.



Measuring waiting times across OECD countries

The measurement of waiting times varies widely across OECD countries. This chapter gives an overview of different measures of patients’ experience of waiting using examples from several countries. Common measures are the in-patient waiting time (from specialist addition to the list to treatment), the out-patient waiting time (from general practitioner referral to specialist visit) and the referral-to-treatment (from GP referral to treatment). Reported figures include the mean waiting times, the waiting time at different percentiles of the distribution (at the 50th percentile, i.e. the median, the 80th, 90th or 95th percentile), and the number of patients waiting more than a threshold waiting time, for example, three, six or nine months. Waiting times are reported in most countries by procedure (e.g. hip and knee replacement, cataract surgery) or by specialty (e.g. ophthalmology, orthopedics). They refer mainly to two distributions: i) the distribution of waiting times of patients treated in a given period (for example, a financial year); ii) the distribution of waiting times of the patients on the list at a point in time (a census date). Most information on waiting times is available from administrative databases from countries where waiting times are a significant policy issue, and less so from survey data.




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