Waiting Time Prioritisation for Public and Private Providers: Evidence From Hip Replacement Surgery

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• Increasing healthcare waiting times in England and OECD countries impact patient health.
• Patient prioritization based on health status is a policy to mitigate waiting time effects.
• Understanding prioritization differences between public and private providers is crucial.

Purpose of the Study:

• To assess the extent of patient prioritization by pre-operative health status for hip replacements in England.
• To investigate whether prioritization differs between public and private healthcare providers.
• To simulate the potential health gains from improved prioritization policies.

Main Methods:

• Analysis of hospital administrative data for hip replacements in England (2015-2021).
• Examination of inpatient waiting times (specialist addition to list to admission).
• Simulation modeling of prioritization policy impacts on Quality-Adjusted Life Years (QALYs).

Main Results:

• Evidence of inpatient waiting-time prioritization based on pre-operative health, with at least a 15-day difference between lowest and highest health status patients.
• Prioritization gradient steepens with longer waiting times and significantly during the COVID-19 pandemic.
• Limited evidence of outpatient waiting-time prioritization; differences between public and private providers attributed to casemix and shorter average waits in private sector.

Conclusions:

• There is evidence of inpatient waiting-time prioritization by health status, particularly for longer waits and during crises.
• Limited prioritization observed in outpatient settings; differences between provider types are complex.
• Improved prioritization policies could yield substantial health gains (e.g., 183 QALYs annually), indicating scope for policy enhancement.