In countries with publicly financed health care systems, waiting time—rather than price—is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients’ socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients’ reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.
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The central government has a residual power and its main function is to coordinate and to lead processes involving the entire SNHS.
The 2011 Spanish Health Survey is also available but its questionnaire does not include information on waiting times by specialties which is essential for the purposes of this research.
According to the modified OECD equivalence scale, weights are distributed as follows: 1 for the first adult, 0.5 for the rest of individuals older than 14 and 0.3 for each child under 14.
And even if it were available, there might be differences across doctors regarding both thresholds for need and notions of priority.
MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Barómetro Sanitario. Informe Anual. Madrid (2011)
MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Sistema de Información de Listas de Espera. Madrid (2011)
Van Doorslaer, E., Wagstaff, A., Van De Burg, H., et al.: Equity in the distribution of health care in Europe and the US. J. Health Econ. 19, 553–583 (2000)
Abásolo, I., Manning, R., Jones, A.: Equity in utilisation of and access to public sector GPs in Spain. Appl. Econ. 33, 349–364 (2001)
Van Doorslaer, E., Koolman, X., Jones, A.: Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 13, 629–647 (2004)
Propper, C., Eachus, J., Chan, P., Pearson, N., Davey Smith, G.: Access to health care resources in the UK: the case of care for arthritis. Health Econ. 14, 391–406 (2005)
Morris, S., Sutton, M., Gravelle, H.: Inequity and inequality in the use of health care in England: an empirical investigation. Soc. Sci. Med. 60(6), 1251–1266 (2005)
Van Doorslaer, E., Masseira, C., Koolman, X.: Inequalities in access to medical care by income in developed countries. Can. Med. Assoc. J. 174(2), 177–183 (2006)
Dixon, A., Le Grand, J., Henderson, J., Murray, R., Poteliakhoff, E.: Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization. J. Health Serv. Res. Policy 12, 104–109 (2007)
Vallejo-Torres, L., Morris, S.: Income-related inequity in health care utilisation among individuals with cardiovascular disease in England—accounting for vertical inequity. Health Econ. 22(5), 533–553 (2013)
Wagstaff, A., Van Doorslaer, E.: Equity in health care finance and delivery. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of Health Economics. Elsevier, Amsterdam (2000)
Pell, J., Pell, A., Norrie, J., Ford, I., Cobbe, S.: Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ 320, 15–19 (2000)
Fitzpatrick, R., Norquist, J., Reeves, B., et al.: Equity and need when waiting for total hip replacement surgery. J. Eval. Clin. Pract. 10(1), 3–9 (2004)
Hacker, J., Stanistreet, D.: Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England. J. Public Health 26(1), 56–60 (2004)
Arnesen, K., Eriksen, J., Stavem, K.: Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management. Health Policy 62(3), 329–341 (2002)
Kee, F., Gaffney, B.: Priority for coronary artery surgery: who gets by-passed when demand outstrips capacity? Q. J. Med. 88(1), 15–22 (1995)
Löfvendahl, S., Eckerlund, I., Hansagi, H., Malmqvist, B., Resch, S., Hanning, M.: Int. J. Qual. Health Care 17(2), 133–140 (2005)
Coyte, P., Wright, J., Gillian, M., et al.: Waiting times for knee-replacement surgery in the United States and Ontario. New Engl. J. Med. 331(16), 1068–1071 (1994)
Kelly, K., Voaklander, D., Johnston, W., Suarez-Amador, M.: Equity in waiting times for major arthroplasty. Can. J. Surg. 45(4), 269–276 (2002)
Shortt, S., Shaw, R.: Equity in Canadian health care: does socioeconomic status affect waiting times for elective surgery? Can. Med. Assoc. J. 168(4), 413–416 (2003)
Cooper, Z., McGuire, A., Jones, S., Le Grand, J., Titmuss, R.: Equity, waiting times and the NHS reforms: retrospective study. BMJ 339(b3264), 1–7 (2009)
Siciliani, L., Verzulli, R.: Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE. Health Econ. 18, 1295–1306 (2009)
BOE: Boletín Oficial del Estado. Real Decreto 605 de 23 de Mayo: medidas para el tratamiento homogéneo de la información sobre las listas de espera en el Sistema Nacional de Salud, 134, 5 Junio (2003)
Congdon, P.: Applied Bayesian Hierarchical Methods. CRC Press/Chapman & Hall, Florida (2010)
MSPSI: Ministerio de Sanidad, Política Social e Igualdad. Encuesta Nacional de Salud. Madrid (2006)
MacNab, Y.: Hierarchical Bayesian modeling of spatially correlated health service outcome and utilization rates. Biometrics 59(2), 305–316 (2003)
Allenby, G., Rossi, P.: Hierarchical Bayes models: a practitioner’s guide. In: Grover, R., Vriens, M. (eds.) The Handbook of Marketing Research. Sage, New York (2006)
Ogle, K.: Hierarchical Bayesian statistics: merging experimental and modeling approaches in ecology. Ecol. Appl. 19, 577–581 (2009)
Browne, W., Draper, D.: A comparison of Bayesian and likelihood-based methods for fitting multilevel models. Bayesian Anal. 3, 473–514 (2006)
Lambert, P.C., Sutton, A.J., Burton, P.R., Abrams, K.R., Jones, D.R.: How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS. Stat. Med. 24, 2401–2428 (2005)
Browne, W., Goldstein, H.: An Introduction to Bayesian Multilevel Hierarchical Modelling using MLwiN; Centre for Multilevel Modelling, London (2002)
Greene, W.H.: Econometric Analysis, 6th edn. Prentice Hall, Upper Saddle River (2008)
Maddala, G.S., Lahiri, K.: Introduction to Econometrics, 4th edn. Willey, West Sussex (2009)
Wooldridge, J.: Econometric Analysis of Cross Section and Panel Data, 2nd edn. MIT Press, Cambridge (2010)
Williams, A.: Priority setting in public and private health care: a guide through the ideological jungle. J. Health Econ. 7, 173–183 (1988)
Neal, R.D., Allgar, V.L.: Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’. Br. J. Cancer 92, 1971–1975 (2005)
O’Donnell, C.: Variation in GP referral rates: what can we learn from the literature? Family Pract. 17, 462–471 (2000)
This paper derives from a research project funded by the Spanish Ministry of Economy and Competitiveness (project ECO2012-36150). The authors are greatful to the Ministry for financial support. We are also grateful for comments on a first version of this paper to the participants at the Sheffield School of Health and Related Research Seminars, on the 30th July 2009. We are also thankful for comments of the two anonymous referees from EJHE. The usual disclaimers apply.
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Abásolo, I., Negrín-Hernández, M.A. & Pinilla, J. Equity in specialist waiting times by socioeconomic groups: evidence from Spain. Eur J Health Econ 15, 323–334 (2014). https://doi.org/10.1007/s10198-013-0524-x
- Waiting times
- Specialist visits
- Hierarchical Bayesian models