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Room: Congress Hall B
Time: Thu 16:00 PM-17:15 PM

Waiting Times and Prioritisation

Chair: Jan Erik Askildsen (University of Bergen)

Session Description

Background. Waiting times are a major concern in many European countries, like Denmark, Italy, Finland, the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom. Waiting times for elective procedures, such as cataract surgery, hip and knee replacement, and varicose veins, can reach up to nine months. In the absence of other rationing mechanisms, waiting times may help to equilibrate demand for and supply of health care by deterring patients with small benefit from asking for treatment. Waiting times generate dissatisfaction for patients by postponing patients’ benefits, deteriorating the health status of the patient, and generating uncertainty. However, waiting times are perceived as an equitable mechanism, as the cost or disutility to the patient generated by waiting does not depend on their ability to pay. A common policy to reduce waiting times is to introduce waiting-times targets, often in conjunction with a waiting-time guarantee. Waiting-time targets or guarantees may generate perverse incentives if the satisfaction of the target is obtained by giving higher priority to less severe patients.
Objectives. The session aims at providing empirical evidence on: i) the effect of waiting-time targets or guarantees; and, ii) the prioritisation of patients by socio-economic status and health condition. The session will draw from the experience of England, Norway, Portugal and Scotland.
I) The first study compares the distributional consequences of two different waiting times initiatives (recently introduced in Norway and Scotland). The primary focus of Scotland’s recent waiting times reforms has been on maximum waiting times. Performance against the targets was monitored monthly and failure resulted in managerial sanction. The focus of the 2004 reform in Norway was on appropriate prioritisation of patients by waiting times. The analysis shows that the distribution of waiting times changed relatively little in Norway after the reform was introduced. In Scotland however, we see some substantial distributional effects.
II) The second study investigates the effect of introducing a waiting-time target on the distribution of waiting times in Portugal. Since the target was introduced in some hospitals but not in others, we use the latter as a control group. Using Difference-in-Difference methods, we find no evidence that the introduction of the targets reduced waiting times.
III) The third study uses duration analysis to investigate the effect of the introduction of the individual maximum waiting time in Norway. The results show that men have slightly lower hazard rates than women, elder patients have higher hazard rates and higher DRG-weights lead to shorter survival times. When it comes to the maximum waiting days, it seems that less prioritised patient groups wait longer compared to the most prioritised group. There is also an indication that the tumour patients are prioritised most, compared to other medical groups.
IV) The fourth study tests whether patients with lower socioeconomic status (as measured by small area level income and skill deprivation) are given higher priority when waiting for hip replacement in the English National Health Service. It provides evidence of inequity in waiting times favouring more educated individuals and, to a lesser extent, richer individuals.

Session Organizer: Luigi Siciliani (University of York)

Presentations

1. The impact of maximum waiting time targets in Norwegian hospitals

   Presenter: Jurgita Januleviciute (University of Bergen)

2. Waiting times and socioeconomic status: evidence from England

   Presenter: Luigi Siciliani (University of York)

3. How do waiting times initiatives change prioritisation concerning patient characteristics? A comparative analysis of Norway and Scotland

   Presenter: Matt Sutton (University of Manchester)

4. The effects of targets on waiting time prioritisation: evidence from Portugal

   Presenter: Pedro Pita Barros (Universidade Nova de Lisboa)