Effect of fundholding on waiting times: database study

Area of Science:

• Health Services Research
• Healthcare Management
• Surgical Access

Background:

• Healthcare systems face challenges in managing surgical waiting lists.
• The introduction of fundholding aimed to empower primary care practices with greater control over healthcare resources.
• Assessing the impact of fundholding on patient access to elective surgery is crucial for healthcare policy.

Purpose of the Study:

• To evaluate if fundholding patients experience shorter surgical waiting times compared to non-fundholding patients.
• To determine if the attainment of fundholding status by practices is directly linked to reduced waiting times for surgery.

Main Methods:

• A comparative analysis of waiting times for elective surgery was conducted.
• Data from over 57,000 patients across four providers in West Sussex between 1992-1996 were analyzed.
• Waiting times were compared between fundholding and non-fundholding patients, and also longitudinally for practices transitioning into the fundholding scheme.

Main Results:

• Fundholding patients consistently experienced significantly shorter waiting times for elective surgery across all providers and study years.
• A notable decrease in waiting times was observed specifically in the year practices joined the fundholding scheme.
• No significant reduction in waiting times was seen prior to practices becoming fundholders.

Conclusions:

• The fundholding scheme demonstrably shortens waiting times for elective surgery.
• Potential explanations include the benefits of practice-level purchasing of surgical services or potentially overgenerous funding within the scheme.
• These findings suggest that devolved purchasing power at the practice level can enhance surgical access.