Waiting Times Flashcards
Problems with long waiting times?
Political pressure
Prolonged suffering
Delayed benefit
Uncertainty
What did Sicilliani et al (2014) show about mean waiting times in the UK?
Graphs of mean waiting time for hip replacements in the UK
250 days - 2000
Less than 100 - 2008
What did Sicilliani et al (2014) show the mean waiting times was for a hip replacement in the Netherlands?
Consistently around 50 days in 2008
What is the difference between list and waiting time?
List: Length of the list waiting for the procedure
Time: Duration of each individuals wait
Different methods/versions of measuring waiting time?
Time v List Outpatient v Inpatient Speciality/procedure timings Elective v Emergency Mean v Median Waiting over 8/12 months
Problem with measuring those treated on the list?
Can get affected by the number of high/low priority patients
What did Scilliani and Hurst (2005) say about different ways of measuring waiting times?
- Mean is always higher than the median as it is impacted by large outliers
- Often closely align but can show clear differences
What is Martin and Smith do in their 2003 paper?
Used panel data to model waiting times in the NHS
With the demand graph for waiting time what happens in there is a positive shock in demand?
Increase in waiting time and in activity (Demand line shifts to the right)
Why is the demand curve for waiting times downward sloping?
People will move to the private sector if the wait is too long
With the supply graph for waiting time what happens in there is a increase in funding?
Supply line moves down, supplies increase and the waiting time reduces
Why is the supply curve sloped?
At longer waiting times hospitals act to treat more people, this may be to do with doctors concerns for patients, targets or political pressure
What makes up the utility curve for elective treatment?
benefit, waiting time, other consumption minus the cost of searching for treatment
U = ( b , w , c ) - F
What makes up the utility curve for public treatment?
benefit, waiting time, gross income minus the cost of searching for treatment
U = ( b , w , y) - F
What makes up the utility curve for private treatment?
benefit, waiting time, gross income minus the cost of treatment all minus the cost of searching for treatment
U = ( b , 0 , y - p ) - F
What makes up the utility curve for no treatment?
U = ( 0 , 0 , y ) - F
When will someone opt for public treatment?
U public > U private and U no treatment
Explain the graph for public / private treatment?
- Benefit on vertical, income on horizontal,
- No treatment horizontal line near the bottom
- Waiting line, slight downward diagonal to the right, anything to the right is private, left is public
Which lines shift if the waiting times change in the public/private treatment graph?
No treatment (up if times increase) Wait time (Shifts left if it increases)
Marginal cost of supply is equal to?
The marginal benefit of lower waiting times
What coefficients are in the empirical equation to estimate demand?
Waiting time (-) , need indicator, private bed supply and an error term
What coefficients are in the empirical equation to estimate supply?
Waiting time (+), public beds, number of doctors and an error term
What did Martin (2003) show the demand curve number was?
-0.2 (inelastic, high slope)
What did Martin (2003) show the supply curve number elasticity was?
+5.29
What did Martin and Smiths study show?
That an increase in resource will significantly reduce waiting times
What is an instrumental variable, why did Martin use it?
You need a factor than is a good predictor of waiting times that won’t affect the demand (or supply) in the equation e.g. more beds should reduce waiting times without affecting the supply
What did Propper et al (2008) write a paper on?
The natural experiment when England introduces targets for waiting times and Scotland didn’t
What did Propper et al (2008) say about the effects of targets?
Large effect of targets, massive fall of 6.59% points. Converged to the lower waiting times of Scotland
Why does Dimakou (2009) criticise targets?
- Guarantee applies to all patients, even those of a low severity. Doesn’t prioritise need
- More likely to get treated near the target time, but once it has been missed likelihood of treatment falls
Type of waiting times introduced in England v Norway?
England: Max wait guarantee for all patients
Norway: Conditional guarantee for those with a higher need
What does Askildsen (2010) say Norways current waiting time policy is like?
Patients placed into 3 groups (acute, non-urgent with guarantee, and non-urgent procedures with no guarantee). If maximum wait is exceeded for group 2 then they can get private cover
Should there be inequity in waiting times?
No, in theory as it is a service available to all (in the UK) and not on ability to pay the wait should not differ depending on socio-economic status
What did Cooper (2009) assess about NHS waiting times for hip replacements and socio-economic groups?
In 1997 waiting times and deprivation tended to be positively related. By 2007 the relation between deprivation and waiting time was less pronounced, and, in some cases, patients from the most deprived were waiting less time than the most advantaged
What did Laudicella (2012) discover about inequalities within one hospital in the UK?
Most deprived could wait 13% longer!
Rich men wait 14% less, education didn’t matter
Educated women wait less, income doesn’t matter
What did Siciliani (2009) find about inequalities looking at SHARE survey data?
Found inequalities across income and education (survey only includes those 65+)
Why could inequalities exist relating to income/education?
- Better social networks
- Active complainers
- More likely to attend appointments/ follow advice?
What did Borowitz (2013) summarise about OECD countries approaches to waiting times? Give examples?
Max waiting times the most popular policy but it is implemented differently across countries
Give examples of different countries policies to reduce waiting times according to Borowitz (2013)?
England & Finland: Targets and sanctions
Denmark & Portugal: Choice/Competition/Private sector
New Zealand and Canada: Prioritisation
Hurst (2004) explanation of Finnish waiting time policies?
In 2000 they had bad waiting times, some of the longest in Europe. Introduced max waiting time guarantee. Large reductions in waiting times following the policy! Penalised by a strong regulator (Valvira), however waiting times worsened if the regulator relaxed sanctions
Explanation of Denmark’s approach to reducing waiting times?
Limits introduced, and further reduced over time. If you wait over the time you can either go private or to another regions public hospital. The cost is then covered by your region (who failed to meet the target). Up to 4% rise in private sector usage, small decline in waiting times
What did the Netherlands do to reduce waiting times?
- Introduced socially acceptable limits (not a guarantee), -80% in a shorter target, and an additional 20% in a slightly longer time. e.g. 3 and 4 weeks for a specialist.
- Activity based financing (changed output payments)
Were the Dutch measures were effective?
Yes reduced the waiting times 3 fold. Reductions from 16 weeks to 5 weeks! (2000 - 2011)
Problems with the Netherlands measures?
- Expenditure increased rapidly
- Extra resources not allocated efficiently
How many people on NHS waiting list according to Martin and Smith (1999)? Average wait?
1,000,000 (over)
4 months
How much does the UK spend on the NHS?
UK spent 9.8% of its GDP on health in 2014.
What did Buttery argue in 1980?
Waiting lists are not connected with surgical provisions, argues more funding will increase demand
What did Martin and Smith argue about resources and waiting times?
The extra resources will strongly reduce waiting times, with minimal increase in demand
Where did Propper et al (2008) say the largest impact was from the targets?
Those waiting over 6 months or more, fell 60%
What did Hurst and Sicilani (2003) say about Spains waiting time policy?
Marked fall after linking financial incentives to achieving targets in 2008
Problems with targets according to Hurst and Sicilani (2003)?
Demand will increase after a brief period, pushing waiting times back up. Tech changes can also increase demand (better quality treatments etc)
What did NZ and Australia do to reduce waiting times?
NZ: Demand management, strict clinical guidelines on prioritising patients
AUS: Increased tax incentives to get private healthcare
What did Hacker (2004) discover about waiting times in a UK hospital?
Routine waiting list systems are not always delivered equitably. For one speciality, female, older and deprived patients were significantly more likely to experience longer than average waits
