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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.

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Waiting times for health care: A conceptual framework

This chapter provides a conceptual framework for understanding the role of waiting lists and waiting times in the health sector, with a special focus on hospital services. It emphasises demand-side and supply-side factors that influence excessive waiting times, and in particular the critical role of doctors in determining the demand for care. It then briefly describes the health policy significance of waiting times across the OECD countries, and the extent to which this is associated with health spending and the supply of hospital beds and doctors. There is a negative association between waiting times and the availability of curative care beds, and to a lesser extent with public health expenditure per capita. It then briefly reviews the empirical evidence on the effect of waiting times on health outcomes. This suggests that long waiting times can have a detrimental impact on health outcomes for more urgent procedures, like coronary bypass, but less so for less urgent ones, like elective hip replacement, where the evidence is mixed. It also highlights the recent empirical literature, which suggests that waiting times for publicly funded patients may be longer for individuals with lower socioeconomic status, making waiting times a less equitable allocation mechanism than currently perceived.

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