Case study

Reducing waiting times in hospitals

York research informed guidance issued to Organisation for Economic Co-operation and Development countries on reducing hospital waiting times.

The issue

Lengthy waiting times are a major source of patient dissatisfaction, can prolong suffering and can also result in a patient's health getting worse.

Implementing effective policies that reduce waiting times clearly has benefits for patient wellbeing. Many countries which are part of the Organisation for Economic Co-operation and Development (OECD) have introduced a range of policies to tackle excessive waiting times, and it is important to understand which policies work.

The research

In 2013 Professor Luigi Siciliani and colleagues conducted a review of waiting time policies in 12 OECD countries. Working with data collected over a ten-year period, the team analysed trends in the length of waiting times to measure policy effectiveness.

Across the countries the team surveyed, the most common policy was to have a maximum waiting time. The policy was practiced in three distinct ways:

  • The maximum waiting time was used as a target. If patients were waiting beyond that target time, their healthcare providers received penalties. This practice was adopted by England and Finland.
  • A maximum waiting time was combined with incentives related to choice and competition. Patients who wait more than the maximum time were entitled to seek treatment in other public hospitals or, sometimes, in a private hospital at the expense of the public system. This approach was practiced in Denmark, the Netherlands and Portugal.
  • Maximum waiting time was used as an indication of the severity of a patient's condition, functioning as a tool for prioritisation. This was the case in New Zealand and Canada.

The first two approaches did have success, but in some cases were associated with cost increases. The third approach can be helpful to improve prioritisation, but can be difficult to implement.
In many countries, the maximum waiting time length varied depending on the nature of the treatment; shorter maximum waiting times applied to urgent care, such as cancer treatment, while elective treatments were subject to longer maximum waiting times.

Some countries have attempted to tackle waiting times by increasing the supply of services. A key insight of this research was that these policies on its own do not bring down waiting times in the long-term unless demand is kept under control by adopting maximum waiting times.

The outcome

Our research into waiting times informs policymakers around the world that want to address this important issue.

The OECD report Waiting time policies in the health sector, what works? is a key reference for policymakers who design policies aimed at reducing waiting times.

In 2014 Professor Siciliani presented a review of waiting times to the Northern Ireland Assembly's Committee for Health (then known as the Committee for Health, Social Services and Public Safety).

Featured researcher

Luigi Siciliani

Professor Siciliani specialises in the economics of hospitals. He has published 70 articles in peer-reviewed journals. His research interests include waiting times for non-emergency treatment, hospital quality competition, contracting theory applied to healthcare, pay for performance and coordination between health and social care.

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