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Waiting time prioritisation: Evidence from England.

Nils Gutacker¹, Luigi Siciliani², Richard Cookson¹

¹Centre for Health Economics, University of York, UK.

Social Science & Medicine (1982)

|May 17, 2016

Summary

Severely ill patients receive shorter hip and knee replacement wait times, with pain being a key prioritization factor. This prioritization occurs even without formal policies, especially in hospitals with longer queues.

Keywords:

England Patient-reported outcome measures Prioritisation Severity Waiting times

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Published on: November 26, 2013

Area of Science:

Health Services Research
Health Economics
Orthopedic Surgery

Background:

Many OECD countries implement waiting time prioritization policies for severely ill patients.
Empirical evidence on actual patient prioritization practices is limited.
Understanding prioritization is crucial for equitable healthcare resource allocation.

Purpose of the Study:

To investigate how patients are actually prioritized for hip and knee replacements.
To examine the association between patient severity (pain and immobility) and waiting times.
To assess the influence of formal prioritization policies and hospital waiting times on prioritization outcomes.

Main Methods:

Utilized a large national dataset of nearly 400,000 patients in England (2009-2014).
Linked patient-reported outcome measures (PROMs) data with administrative data for publicly funded hip and knee replacements.
Analyzed the relationship between patient-reported pain and immobility and actual waiting times.

Main Results:

Patients with the most severe pain and immobility experienced significantly shorter waits.
Wait time differentials were approximately 24% shorter for hip replacement and 11% for knee replacement.
Prioritization was more strongly associated with pain than immobility and was more pronounced in hospitals with longer average waiting times.

Conclusions:

Healthcare providers prioritize patients based on severity, particularly pain, even in the absence of formal policies.
These findings suggest that clinical judgment plays a significant role in managing waiting lists for orthopedic procedures.
The study highlights the importance of patient-reported outcomes in understanding and potentially improving healthcare access and equity.