Abstract
Waiting times for elective surgery are a key issue for the NHS. The principal policy response in the English NHS has been to introduce maximum waiting time targets against which performance is measured and rewarded. The aim of this paper is to identify the effect of government targets on the distribution of waiting times in the NHS. Specifically, we investigate the following questions: How does the probability of admission for any given patient vary during the time that they wait? How is the probability of admission for any given waiting time affected by the targets? Can variations in waiting times be explained by clinical, patient, or provider-level characteristics? What implications may be drawn from our results with respect to providers’ managerial responses to the targets? This paper investigates these questions by applying duration analysis techniques to waiting time data from 2001/2002 and 2002/2003 for three specialties: general surgery, trauma & orthopaedics and ophthalmology. Estimation of survival functions reveals considerable variations in waiting times between specialties, operative procedures and hospitals. Hazard rates vary over time and peaks in them—high probabilities of admission—coincide with targets and change when targets change. Amongst patient characteristics, whether they are NHS or private and whether they are day or inpatient cases both influence waiting times, but other characteristics such as age, sex and ethnicity do not.
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References
Siciliani L, Hurst J (2003) Explaining waiting times variations for elective surgery across OECD countries, OECD Health Working Papers No.7. OECD, Paris
Gravelle H, Smith P, Xavier A (2003) Performance signals in the public sector: the case of health care. Oxf Econ Pap 55:81–103
Hamblin R, Harrison A, Boyle S (1998) Waiting lists. The wrong target. Health Services J 108:28–31
Department of Health (2000) The NHS plan: a plan for investment, a plan for reform. Cmd 4818-I. HMSO, London
Harrison A, Appleby J (2005) The war on waiting for hospital treatment—what has labour achieved and what challenges remain? King’s Fund, London
Appleby J, Boyle S, Devlin N, Harley M, Harrison A, Thorlby R (2005) Do English NHS waiting times targets distort treatment priorities in orthopaedics? J Health Serv Res Policy 10:167–172
http://www.performance.doh.gov.uk/waitingtimes/index.htm (Accessed March 26th 2007)
National Audit Office (2001) Inpatient and Outpatient waiting in the NHS. Report by the Comptroller and Auditor General. HC 221 Session 2001–2002: 26 July 2001. National Audit Office: TSO, London
Culyer AJ, Cullis JG (1976) Some economics of hospital waiting lists in the NHS. J Soc Policy 5(3):239–264
Hadorn DC, Holmes AC (1997) The New Zealand priority criteria project. Part 1: Overview. BMJ 314:131
Cox DR, Oakes D (1984) Analysis of survival data. Chapman and Hall, London
Collett D (1994) Modelling survival data in medical research. Chapman and Hall, London
Appleby J, Boyle S, Devlin N, Harley M, Harrison A, Locock L (2003) Sustaining reductions in waiting times: identifying successful strategies. Report commissioned by the Department of Health Policy Directorate. King’s Fund, London
Appleby J, Devlin N (2004) Measuring success in the NHS. Using patient-assessed health outcomes to manage the performance of health care providers. Dr Foster, London
Department of Health (2003) A code of conduct for private practice: guidance for NHS Medical Staff. Department of Health, London (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100689 Accessed on March 26th 2007)
National Audit Office (2001) Inappropriate adjustments to NHS waiting lists. Report by the Comptroller and Auditor General. HC 452 Session 2001–2002: 19 December 2001. National Audit Office: TSO, London
Acknowledgements
We are grateful to the UK Department of Health for allowing us access to HES data. We thank for their helpful comments participants at the Health Economists Study Group meeting at Oxford, 2005, and the European Health Economics Conference in Budapest, 2006.
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Dimakou, S., Parkin, D., Devlin, N. et al. Identifying the impact of government targets on waiting times in the NHS. Health Care Manag Sci 12, 1–10 (2009). https://doi.org/10.1007/s10729-008-9069-4
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DOI: https://doi.org/10.1007/s10729-008-9069-4