Is Patient Choice an Effective Mechanism to Reduce Waiting Times? (original) (raw)
Related papers
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.
An empirical analysis of the impact of choice on waiting times
Health Economics, 2007
Policy-makers often claim that enhancing patient choice induces more competition among hospitals and may therefore reduce waiting times. This paper tests this claim using 120 English NHS hospitals over the period 19992001. Several proxies for the degree of ...
2018
We study hospital choice in the publicly funded National Health Service in England, using a two sample strategy to identify a structural model of demand for elective procedures. In the NHS patients are allowed to opt out from the market of free-of-charge public hospitals and choose a private provider; we find that the outside option has an important effect on competition, patient choice and elasticities compared with traditional models ignoring the private sector. Considering endogeneity of waiting-time, proper measures of quality and the existence of private sector, we find substantially different policy conclusions compared to existing hospital demand models.
2019
Background: Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation. Methods: We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog).Results: From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing “first come, first served” instead of prioritisation. Conclusion: A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.
Waiting time prioritisation: Evidence from England
Social Science & Medicine, 2016
Waiting time prioritisation policies are increasingly common amongst OECD countries. The key idea is that patients with higher severity and higher marginal disutility of waiting should be prioritised on the list and therefore wait less. There is however very little empirical evidence on the extent to which doctors prioritise patients on the list. This paper fills this gap in knowledge. We use administrative data on all hip and knee replacements patients waiting in England over the years 2009-12 and link those to data from the national patientreported outcome measures survey in England. These data provide a unique opportunity to severity before surgery accurately and explore the relationship between severity and waiting times. Our regression results show that patients with higher severity tend to wait less, as expected, but the degree of prioritisation is surprisingly low. We also test whether the degree of prioritisation differs between hospitals with long and short waiting times. We find that the gradient is steeper in hospitals with longer waiting times. The finding has implications for countries which have been hit by the financial crisis leading to fewer resources for their health systems and longer waiting times for elective patients.
Health Economics, 2005
We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis is novel in that it focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between outpatient visits, inpatient admissions, daycase treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply.
Mapping choice in the NHS: cross sectional study of routinely collected data
BMJ, 2005
Objective To identify where in England there are likely to be most constraints on choice of hospital for patients waiting longer than six months for elective care. Design Cross sectional study using routinely collected data. Setting Population of England and NHS trusts and private sector hospitals in England. Participants All residents in England. Main outcome measures Availability of beds (available and unoccupied hospital beds), demand (number of people waiting longer than six months), and access (travel time to facilities) to hospital care in England. Results Most people in England already have an extensive potential choice of hospital. The number of available and unoccupied beds within 60 minutes' travel time was lowest in the Scottish borders, North Yorkshire, and parts of East Anglia, Lincolnshire, Devon, and Cornwall. This pattern was not altered by adding in private facilities. Putting demand with this supply, the number of people in a geographical area waiting longer than six months per bed within 60 minutes' travel time was highest in the south east (except London), parts of the south west (Cornwall, Bristol), East Anglia, and the Welsh border. Conclusion People in the south east (outside London), East Anglia, and parts of the south west are likely to have to travel further to exercise meaningful choice of hospital for elective care.
Mapping choice in the NHS: Analysis of routine data
2005
Background New policies in the National Health Service in England seek to extend the choice of provider of care for patients on waiting lists for elective surgery. We try to identify where in the country there are likely to be most constraints on choice for patients waiting over 6 months for elective care.
Quality decreases from introducing patient choice in a National Health Service
Portuguese Economic Journal
A view often expressed about patient choice of health care providers is that it will increase competition between providers, which benefits the efficiency of the health system. We address here a patient choice initiative, regarding selection of hospital for specialty consultations, in the Portuguese National Health Service (NHS) that has two specific features. The first feature involves shared decision making between patients and GPs, in the choice of hospital for referral, which should be based on publicly available information on "quality". The second specific feature is that the patient choice initiative did not involve payment changes to NHS hospitals associated with patients' movements. We show that explaining initial asymmetries in qualities (waiting times) with systematic differences in hospital characteristics (cost advantages and managerial talent) leads to potential asymmetric responses to the introduction of patient choice in the NHS. This implies that the empirical analysis has to accommodate such asymmetries. Explicitly allowing for asymmetries in responses to the policy measure reveals that reactions were indeed different, with top-performance hospitals reducing their qualities (increasing waiting times) after the patient choice initiative was introduced.