UK Professor: Rationing by Waiting Isn’t All Bad
Everyone knows there is a downside to waiting for care. People get sicker. They cannot work and need others to care for them. Some end up permanently disabled. Others die. Once care is delivered, sicker patients take longer to recover. And full recovery may never be achieved.
But have you ever considered the positive side of rationing by waiting? If not, take a look at a 2004 editorial in the Journal of the Royal Society of Medicine by Professor Nick Black of the Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene and Tropical Medicine. Professor Black says surgical waiting lists have their good points, especially if they are “well managed.”
Waiting lists are good for health care system efficiency and, according to Black, the number of patients treated is a better measure of quality than the length of time spent waiting.
The benefits of waiting lists? Waiting lists create steady demand and an interesting case mix, improving the morale of health care providers. Patients benefit, because even if they’ve been referred for surgery, the waiting list gives them additional time to wait for spontaneous resolution.
Moreover, Professor Black considers it a benefit that waiting lists give patients additional time to prepare themselves, practically and psychologically, for their operation.
In Professor Black’s own words:
Waiting lists are a feature of all countries with a publicly funded health system, such as Spain, Australia, New Zealand, Canada, The Netherlands, Ireland, and the UK. Despite countless well-meaning initiatives in all countries to eliminate them, their persistence continues to infuriate and frustrate government and other public payers. But should it? Can waiting lists be eliminated?
Before addressing that question, it is important to recognize that, while prolonged waiting (say, over six months) is clearly undesirable, not only for humanitarian and economic reasons but also because clinical outcomes may be worse, benefits can result from a well-managed waiting list. It maximizes efficiency by ensuring a steady demand for precious resources such as staff, theatres and beds. It also enhances staff satisfaction and morale by ensuring theatre lists have an interesting mix of cases, and enables training needs to be met. From the point of view of some diseases (such as otitis media with effusion or benign prostatic hyperplasia), waiting for surgery provides a period for spontaneous resolution of symptoms and, therefore, the avoidance of unnecessary surgery. And for those whose condition does not improve, it allows them time to either reconsider their decision or prepare, both practically and psychologically, for the operation…
…rather than attempt to eliminate waiting lists, public healthcare systems should seek to improve the management of surgical services and payers should focus on the numbers of patients treated rather than the number awaiting treatment, which, as has been demonstrated, will remain resistant to change.
At the time that Black wrote this editorial, the United States had virtually eliminated waiting lists for surgery. Its hospitals were more efficient than those of the NHS and its medical schools managed to adequately train physicians. It had also treated larger and larger numbers of patients as its population grew. Americans patients referred for surgery had already determined that their symptoms wouldn’t resolve without it, and they somehow managed to prepare for their operations without going through long periods of uncertainty about when they would actually be treated.
In the future, however, things may be very different.
Linda, can’t tell if this is tongue in cheek or whether you are serious. I assume the former.
Rationing necessarily occurs in all markets where goods or services are scarce. If society decides it is inappropriate to ration medical care through price mechanisms, the inevitable result is decreases in quality and rationing by waiting. The only other option is huge, unsustainable costs.
I don’t know of any country where waiting lists are well managed. In fact, a “well managed waiting list” is an oxymoron.
If you want “tongue in cheek”, try this:
The roll-out of new goods and services, like the next iPhone, Kindle, Porsche, or flavor of Coca-Cola, is haphazard and puts undue stress on the people who supply these goods to consumers whose demand is unpredictable.
Their morale would be a lot better, plus they’d see a more intresting mix of customers, if the government managed demand of these goods, deciding the time and circumstances under which people could acquire these goods.
Businesses should focus on the number of units sold (according to the government’s schedule), not how much unmet demand there is, or what they think prospective customers will want in next year’s model
That kind of entrepreneurship would only disrupt the government’s demand-management!
“…the waiting list gives them additional time to wait for spontaneous resolution.”
Does death count as spontaneous resolution? And does the NHS keep count of the number of people on a surgical waiting list that reach their alloted surgical appointment and say, “You know, it’s the strangest thing, but my tumor just disappeared last week.”
[…] UK Professor: Rationing by Waiting Isn’t All Bad | Linda Gorman | NCPA […]