Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level (original) (raw)
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Towards a macro model of National Health Service waiting lists
System Dynamics Review, 1999
Waiting lists for elective surgery have been endemic to the UK National Health Service since its inception in 1948. The lists arise as a result of interaction between supply factors (the provision of resources and the eciency of their use) and demand factors (arising from a complex conjunction of the perceptions and preferences of patients and physicians). This article takes the ®rst steps towards the development of a macro model of the NHS waiting list. It adopts an economics perspective and assumes that the waiting time for surgery, as perceived by patients, physicians and managers, is a central in¯uence on the quantity of elective surgery demanded and supplied. Using the methods of system dynamics, econometric results are integrated into a dynamic model that seeks to illustrate the path taken over time by the national system of elective surgery. It explores a number of future scenarios, and ®nds that the NHS will quickly cease to be a universal service if resources fail to keep pace with increases in demand.
An Equilibrium Model of Waiting Times for Elective Surgery in NSW Public Hospitals*
Economic Record, 2011
This article studies the effects of waiting times on the demand and supply of elective surgery in NSW public hospitals. The demand and supply equations are estimated at the level of postal code areas using data on public hospital elective surgery admissions in 2004-2005, postal code area characteristics and area-level provisions of public and private hospital capacities. Empirical results imply that demand for elective surgery is affected negatively, and supply positively, by waiting time. The estimated elasticity of demand with respect to waiting time is higher in NSW than estimates reported in studies based on data from the UK National Health Service.
Waiting times and waiting lists: a model of the market for elective surgery
Oxf. Econ. Pap., to be published, 2003
We present a simple dynamic model of the demand and supply for elective surgery in the NHS and test it using a panel of quartely data for 123 English health authorities from the second quarter of 1987 to the first quarter of 1993. We find that supply is increasing in ...
Health Economics, 2007
Long waiting times for inpatient treatment in the UK National Health Service have been a source of popular and political concern, and therefore a target for policy initiatives. In the London Patient Choice Project, patients at risk of breaching inpatient waiting time targets were offered the choice of an alternative hospital with a guaranteed shorter wait. This paper develops a simple theoretical model of the effect of greater patient choice on waiting times. It then uses a difference in difference econometric methodology to estimate the impact of the London choice project on ophthalmology waiting times. In line with the model predictions, the project led to shorter average waiting times in the London region and a convergence in waiting times amongst London hospitals.
Spanish public hospital waiting lists: a theoretical and empirical approach
Economics, 2017
The main objective of this work is to study the effects that supply and demand factors have on waiting lists. With this aim in mind, the authors discuss a model which explains the factors that can affect the production of healthcare, demand for healthcare, and finally, the inequalities between healthcare supply and demand. This analysis proves that, due to imbalances between supply and demand, there is an excess of demand that is equal to waiting lists. This demand excess is called the waiting list function. Hence, the second part of this paper develops an empirical analysis which estimates the function for the waiting lists of Spanish Public Hospitals for the period 1996–2009. As a result of the estimation, the supply and demand factors influencing waiting lists, as well as their evolution, are determined and studied. An imbalance between supply and demand reduces the supply and increases demand resulting in the amount traded by the market being less than potential demand.
Dynamic hospital competition under rationing by waiting times
Journal of Health Economics, 2019
We develop a dynamic model of hospital competition where (i) waiting times increase if demand exceeds supply; (ii) patients choose a hospital based in part on waiting times; and (iii) hospitals incur waiting time penalties. We show that, whereas policies based on penalties will lead to lower waiting times, policies that promote patient choice will instead lead to higher waiting times. These results are robust to different game-theoretic solution concepts, designs of the hospital penalty structure, and patient utility specifications. Furthermore, waiting time penalties are likely to be more effective in reducing waiting times if they are designed with a linear penalty structure, but the counterproductive effect of patient choice policies is smaller when penalties are convex. These conclusions are partly derived by calibration of our model based on waiting times and elasticities observed in the English NHS for a common treatment (cataract surgery).
Is Patient Choice an Effective Mechanism to Reduce Waiting Times?
Applied Health Economics and Health Policy, 2004
initiatives in secondary care are part of policies aimed at reducing waiting times. This article provides evidence on the effectiveness of patient choice as a mechanism to reduce waiting times within a metropolitan area. The London Patient Choice Project was a large-scale pilot offering patients on hospital waiting lists a choice of alternative hospitals with shorter waiting times. A total of 22 500 patients were offered choice and 15 000 accepted. The acceptance rate of 66% was very high by international standards. In this article we address two questions. First, did the introduction of choice significantly reduce waiting times in London relative to the rest of the country where there was no choice? Second, how were the waiting times of London patients not offered choice affected by the choice regime? We examine the evidence on these issues for one specialty, orthopaedics. A difference-indifference analysis is used to compare waiting times for hospitals within London before and after the introduction of choice. Although there was a small but significant reduction in waiting times in London relative to other areas where there was no patient choice, the main effect of the choice regime was to produce convergence of mean waiting times within London. Convergence was achieved by bringing down waiting times at the hospitals with high waiting times to the levels that prevailed in hospitals with low waiting times. This represented a clear improvement in equity of access, an important objective of the English National Health Service.
International Journal of Health Care Finance & Economics, 2003
In this paper I model the demand for and supply of elective surgery using a modified Hotelling framework in which time, money, and distance are determinants of the demand for hospital care. Hospitals compete with each other in terms of the waiting time and consequently treat a certain number of patients. The basic model of hospital competition is then extended to incorporate the general practitioner (GP) fundholding scheme whereby the GPs are allocated a budget with which to buy care for their patients. Waiting time increases when production of care becomes more expensive, when the benefit obtained from treatment increases, when the unit cost of distance decreases, and when the importance given to time as a performance indicator decreases. The higher the money price the lower the waiting time. Finally, the money price paid by the GP fundholders is greater than that paid by the Health Authorities and greater than the hospitals marginal cost of production. As a consequence, fundholding patients pay a zero time price while non-fundholding patients experiment a positive waiting time.
Variations in appointment delays for physicians' services: Theory and empirical evidence
Policy Sciences, 1978
Waiting times for physician appointments have been used in past studies as a measure of access to, or excess demand pressure on, local ambulatory care systems. This paper offers an alternative view--that short appointment delays are one of several types of amenities produced by physicians in combination with health services. Empirical evidence is presented that illuminates some previously unknown relationships between appointment delays, patient diagnosis, site of care, and family income. A model is developed with the capability of predicting short-run responses to changes in demand for physicians' services. The model and empirical evidence are used as the basis for interpreting recent experience in Canada with its system of national health insurance (NHI) and for predicting potential consequences regarding the production of amenities of NHI in the US.