Waiting Times for Health Services

1. Waiting times remain an important policy issue in most OECD countries

Improving the experience and satisfaction of patients with the health care system is a key policy objective. Reducing the time that people have to wait to get access to health services can go a long way in improving patient experience, so that people don’t feel that they are waiting too long to get proper diagnosis of their health problem and access to treatments to improve their health.

Waiting times can occur for a wide range of health services (Box 1.1). Regardless of the type of health care needed, waiting times are the result of the demand for health services being greater than the supply. This may be due either to capacity constraints or inefficiencies in referral processes and health service delivery, resulting in a queue and patients have to wait. In traditional markets, prices are used to ration goods and services and bring together demand and supply. In the health sector, due to public or private insurance, people face zero or low co-payments and there is therefore very limited reduction in demand due to prices. Instead, in publicly-funded systems, rationing for non-emergency treatment occurs through waiting times. In some health systems, when patients face longer waiting times, some patients may choose not to wait and opt for private treatment, provided they can afford to pay out of pocket or hold private health insurance. This might raise issues of equity in access.

Box 1.1. Different waiting times may occur for different types of health services

Several possible waiting times may arise along the patient journey as shown in Figure 1.1. For non-urgent care, patients will typically seek an appointment with a primary care physician (a general practitioner or GP) and wait from a few hours to several days. Following a GP visit, they may be referred to a specialist and wait days, weeks or months for an appointment. Patients may also wait for a diagnostic test, if required, such as an MRI and CT scan and/or for surgery or other treatment. Waiting for an elective surgical treatment is typically the longest, in the order of weeks, months or even years in some health systems.

Within elective care, certain treatments are more urgent than others if health is likely to deteriorate quickly without intervention, as for cancer and cardiac care. Patients with these health conditions tend to be prioritised over treatments for other conditions where health is less likely to deteriorate, such as for an elective hip replacement or cataract surgery.

Figure 1.1. Possible waiting times for different health services

Source: Adapted from Siciliani, Borowitz and Moran (2013[1]), Waiting Time Policies in the Health Sector: What Works?, OECD Health Policy Studies, https://dx.doi.org/10.1787/9789264179080-en.

Waiting times for health services in publicly-funded systems aim to create equality between patients: patients with similar needs are supposed to wait their turn irrespective of their ability to pay or other non-clinical characteristics. Despite this rationale, several studies have found inequalities in waiting times by income or educational level even in publicly-funded health systems (Siciliani, 2015[2]). Beyond concerns about inequalities, another concern with rationing through waiting times is that the wait may worsen the health outcomes for patients. The available evidence shows that the effect on health outcomes depends on the duration of the wait, the health problem and the clinical prioritisation.

Although patients will seek health care in response to symptoms and illness, doctors have a significant role to play in determining how the demand for better health translates into a demand for health care or other treatments (e.g. pharmaceutical prescriptions). A large body of literature shows that there is unexplained variation in medical practice and overuse of diagnostic tests and procedures, which can be due to clinical uncertainty, clinical traditions and training, and supply-induced demand when activities are paid by fee for service (Wennberg, 2010[3]; OECD, 2014[4]; OECD, 2017[5]).

Responses to the OECD policy questionnaire administered for this project show that waiting times is considered to be either a high priority issue or at least a medium-high priority issue in most OECD countries (Figure 1.2). As expected, these include many countries with a national health system where all the population is covered for services mainly through tax revenues and where waiting times have often been a longstanding issue. However, it is also considered a growing priority issue in some countries that are based on social health insurance systems (such as Luxembourg and Slovak Republic). On the other hand, waiting times is not considered to be a significant policy issue in Germany, Korea, Japan, Switzerland and the United States. However, none of these countries report any statistics on waiting times except for Japan1.

Figure 1.2. Waiting times are an important policy priority in many OECD countries, but not all

Source: Based on responses from 34 countries to the OECD Waiting Times Policy Questionnaire (information is missing from three countries: France, Italy and Turkey).

In some countries, waiting times are considered to be an issue across a wide range of services, while in others waiting times are a significant issue only for some services (Figure 1.3). For example, in the Czech Republic and the Netherlands, waiting times are considered to be an issue mainly for elective treatments and mental health services.

In most countries, the main concern is about waiting times for elective treatments, followed by waiting times for specialist consultations and care. Nonetheless, in at least half of the countries, waiting times are an issue for other services, including primary care/GP consultations, hospital emergency department visits, access to diagnostic tests, as well as to more specific diagnostic and treatment in the area of cancer care, cardiac care and mental health services.

Figure 1.3. Waiting times are considered to be an issue across different types of health services

Source: Based on responses from the OECD Waiting Times Policy Questionnaire 2019.

Note

← 1.  Japan conducts a survey on patient experience every three years, including questions on waiting times. The results for the last wave conducted in 2017 show that the waiting time between the time when a doctor referred a patient for inpatient care and the time when the hospitalisation occurred was within one week for 56% of patients while the proportion who waited more than one month was 13%. The main reasons for waits of over more one month was the limited availability of resources such as beds, diagnostic tests and surgeries (34%) and personal and/or other family circumstances (23%) (Ministry of Health, Labour and Welfare, 2019[54]).