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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.

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Portugal

Waiting lists and waiting times have been an issue for the Portuguese National Health Service (NHS) for a long time. Over the years, several special programmes have attempted to solve the problem. But only after 2005, with the creation of the SIGIC, a waiting time and waiting list management system, do we observe a consistent decrease in waiting times for surgical intervention. The new management system is based on a centralised electronic platform and on a set of rules that allows patients to move within the health system. It also allows for activity-based funding at the margin for hospitals that show the ability to treat more patients in waiting list. Target (maximum) waiting times were set from the start, and then updated to more demanding values after three years of operation. The SIGIC system allows the transfer of patients to another hospital (either public or private) when 75% of the maximum waiting time is reached. The creation of the IT platform on a centralized basis, under a unified set of rules and procedures and with direct access to hospital data, was key to ensuring a detailed knowledge of waiting lists and waiting times across providers, across procedures and across time. This also allowed for more detailed information to be provided to patients (who now have a frequently updated estimate of the likely moment of intervention). The SIGIC has provided a solution for the problem of excessive waiting times whereas earlier programmes that simply provided additional funds for additional activity had failed.

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