Horizontal inequality in rationing by waiting lists

Area of Science:

• Health Services Research
• Health Economics
• Social Determinants of Health

Background:

• Publicly funded healthcare systems often face challenges in equitable resource allocation.
• Waiting lists are a common mechanism for rationing elective procedures.
• Understanding socioeconomic influences on healthcare access is crucial for policy development.

Purpose of the Study:

• To investigate horizontal inequalities in access to six categories of elective surgery.
• To determine if socioeconomic status influences waiting times in a publicly funded system with waiting list rationing.
• To examine the role of income, ethnicity, and gender in healthcare access disparities.

Main Methods:

• Analysis of administrative waiting time data for 4,634 elective surgeries in Ostergötland, Sweden (2007).
• Linking surgical data with national registers for socioeconomic indicators.
• Application of multiple regression analysis to test hypotheses on priority access based on resourcefulness.

Main Results:

• Low disposable household income was associated with significantly longer waiting times for orthopedic surgery (27%) and general surgery (34%).
• No significant disparities in waiting times were detected based on ethnicity or gender.
• The influence of disposable household income on waiting times increased as waiting periods became longer.

Conclusions:

• Horizontal inequalities in access to elective surgery exist, though to a limited extent.
• Socioeconomic factors, particularly income, play a role in healthcare access even when ability to pay is not the rationing mechanism.
• Policymakers must acknowledge the emergence of horizontal inequalities in publicly funded systems to ensure equitable care delivery.