Targets for maximum waiting times and patient prioritisaton: evidence from England
نویسندگان
چکیده
Background: Between 2000 and 2008 the Department of Health (DH) introduced progressively tighter maximum waiting times targets in the English NHS. Health providers responded to these by reducing the waiting times for patients who used to wait substantially longer and increasing the waiting times for patients who used to wait the shortest period of time. However, there is little understanding why we observe this equalising of average waiting times across patient groups. A conceptual framework developed for queuing and scheduling suggests that hospitals were able to meet the waiting times targets by moving away from prioritising patients towards treatment on ”First Come, First Serve” basis. Study Question: This study aims to evaluate and explain how the implementation of maximum waiting time reforms affected patient prioritisation for elective treatment over the 2000-2008 period, and also the effect of the subsequent suspension of these targets in 2010. Methods: Conditional Density Estimation (CDE) approach on a sample of 16,979,542 patient-level observations for four years of Hospital Episode Statistics (HES) data: 1998, 2004, 2008, 2011. Results: Results for cardiovascular diseases are reported in detail. On an aggregate level, our findings support existing results. Our analysis also detects changes in prioritisation between different groups of patients which is a new result for the English NHS. In particular, children and teenagers with large number of co-morbidities waited relatively longer in 2011 compared to 1998. Conclusions: A change in the rule for scheduling for treatment along with increases in capacity can explain the observed equalisation of average waiting times across patient groups and the increase in number of treated patients. Financial pressure in recent years brought increases in waiting times for almost all disease chapters and patient categories. It is unclear whether these changes in priorities reflect medical need. Economics, University of Manchester, Centre for Health Economics, University of Manchester Centre for Health Economics, University of Manchester
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