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Equity in waiting times for major joint arthroplasty
Karen D Kelly1, Donald C Voaklander, William C Johnston
1Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Shepparton, Victoria, Australia. kellyk@unbc.ca
Objective:
To ascertain whether waiting lists are managed in an equitable fashion in a universal health system by examining demographic, socioeconomic and clinical factors, along with 2 health systems variables.
Design:
A prospective survey by questionnaire.
Setting:
The Capital Health Region of Edmonton, Alta.
Patients And Methods:
A cohort of 553 patients, who were waiting for either total hip or total knee replacement surgery, seen between Dec. 18, 1995, and Jan. 24, 1997.
Interventions:
A home visit was made when the patient was first placed on the waiting list and again just before surgery to complete the questionnaires. The Western Ontario and McMaster Universities (WOMAC) instrument and the Medication Quantification Score were administered at the time the patient was placed on the waiting list.
Main Outcome Measure:
The length of waiting time, defined as the date the patient was put on the waiting list to the date the patient was operated on.
Results:
There were no biases in waiting time with respect to age, gender, education or work status. Although pain and function were not related to waiting time, multivariate analyses found that marital status, primary language, body mass index, pain medication use and the size of the surgeons' major joint replacement practice determined waiting time for surgery. However, this model explained only 10% of the variance in waiting time.
Conclusion:
Waiting lists were managed unfairly in terms of clinical equity (clinical severity) but managed fairly in terms of social equity.