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.



Waiting times have been a salient problem in the Swedish health care system since the 1980s. Various initiatives have been taken at the national level since then to come to terms with this problem. The most prominent initiative has been the implementation of waiting time guarantees that set out specific time limits within which patients are to be treated. The last two decades display a pattern of temporarily reduced waiting times due to the guarantees. However, the current guarantee, designed in 2005, seems to have had a more positive, long-term effect on waiting times. More patients than before are receiving treatment and surgery within 90 days. The current guarantee, which was made statutory in 2010, is economically supported by the Queue Billion programme. The economic policy tools were weaker for the earlier guarantees, whereas the Queue Billion provides clear economic incentives for the individual clinics to cut waiting times. There is, however, a need for more thorough research to assess the causal mechanisms behind the reduced waiting times. Economic incentives, administrative interventions such as cleaning the waiting lists, and the purchase of services from other producers are mentioned in some counties as causes of the improvements.




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