Public information about waiting times

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

A number of States in Australia are providing information to the public about average waiting times for elective procedures. The policy is being publicised as a means for GPs and their patients to try to access surgery faster. In additon, elective surgery coordinators have been employed to improve scheduling and waiting list practices, including ensuring that individual patients are on one list and to investigate ways of reducing postponement of surgery.

Purpose of health policy or idea

The stated aims of this policy are to:

• provide patients and their GPs with information about the median wating times for elective surgery by hospital, type of surgery or procedure and specialist doctor. 
• enable them to use this information to decide about referral to a specialist and whether to search for a specialist doctor and/or hospital to improve access to care.
• employ waiting time or elective surgery coordinators at hospitals to imporve scheduling, waiting list practices and reduce the number of postponements.

Main points

Main objectives

Characteristics of this policy

• information is published on a website about waiting times and waiting lists by type of surgery or procedure, urgency classification, public hospital and specialist doctor.
• information is also provided for patients about what questions to ask their GP and specialist doctor, the accuracy of the information provided on the website and what to do if they are concerned about waiting times.
• details of the local Waiting Time Coordinator and Patient Access Coordinator are provided and patients are advised that these people will be able to help them with inquiries.

The data are updated quarterly and relate to the previous 12 months period. Information is also provided about the categories of clinical priority by which patients are categorised. Information is provided for doctors about the completeness of the data, indicating that it provides infomation on public and private booked surgical and medical inpatients in public hospitals in NSW. The information about specialist doctors does not include their work in the private sector.

Type of incentives

Governments, health departments, hospitals and specialist doctors all have incentives to be seen to improve waiting times because the media often report information about this and the public see this as an important issue. Thus, the incentives for the health system are to increase access to clinically relevant care and to decrease complaints about waiting times.

In recent years, most State governments have provided additional funding to reduce waiting times by increasing the staff available and scheduling more surgical sessions per day and per week. They have now provided funding for the coordinators whose task it will be to improve the quality of the services in other ways, ie to reduce the confusion around multiple waiting lists and reduce the number of postponed procedures.

Groups affected

Patients, general practitioners, specialist doctors

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

This policy has the potential to increase access to elective procedures for some patients. However, its impact is dependent on a number of factors:

• awareness, which may vary across GPs and patients
• availability of alternative specialist doctors and hospital beds, which may vary by geographic area

Political and economic background

Waiting times and the length of waiting lists for elective procedures have long been a sensitive political issue in Australia. In recent times, all State and Territory governments have provided additional funding over a sufficiently long period that the problem has been reduced to a large extent. This has led to a situation where the governments are relatively comfortable publishing information about the waiting times for procedures by hospital and specialist doctor.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

Publishing information about the relative quality of care (including access to care) is common in the health systems of developed countries. This type of policy is based on the notion that additional information will be beneficial. In addition, the advent of the World Wide Web has increased the ability of many people to access such information. The development of such information is a consequence of increased expectations by the public that such information will be available and the availability of the Web to provide such information. In Australia, the Council of Australian Governments (COAG), and the Australian Health Ministers Advisory Council (AHMAC) where both State/Territory and Federal government ministers and officials meet regularly, are forums at which such developments are discussed and approved, and if funded, implemented nationally.

Initiators of idea/main actors

• Regierung: All governments in Australia want to be seen to be improving the quality of health services and the provision of information about waiting times is seen as an important aspect of this.

• Meinungsführer: The Australian Medical Association questioned whether the general public would understand the numbers and therefore how useful they would be to people without a medical background

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

The general idea of information being made available and work being done to streamline waiting lists and reduce postponements is supported. All governments recognise the importance of reducing waiting lists and times and have succeeded to some extent. Bureaucrats, having succeeded in persuading governments to fund sufficient surgery to decrease the number of people on the lists and the time they wait, have now persuaded them to fund coordinators to try and deal with the other troubling aspects of elective surgeries; muliple, duplicated lists and postponement of surgery (which is commonly caused by emergencies which have priority). However, the Australian Medical Association (AMA) has questioned the usefulness of the information to people who do not have a medical background, saying that the numbers do not indicate waiting times for triage or assessment.

Actors and positions

Regierung
State governments	sehr unterstützend		stark dagegen
Health bureaucrats	sehr unterstützend		stark dagegen
Meinungsführer
Opinion leaders	sehr unterstützend		stark dagegen

Influences in policy making and legislation

n/a

Actors and influence

Regierung
State governments	sehr groß		kein
Health bureaucrats	sehr groß		kein
Meinungsführer
Opinion leaders	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The implementation of this policy is the responsibility of State/Territory health departments together with local (eg AHS) officials. It is necessary for patients and/or GPs to know about the system, have access to the Workd Wide Web to be able to use it and to choose to adopt the advice contained in the system.

Monitoring and evaluation

There is no formal mechanism for evaluation. However, it would be possible to know how many "hits" there have been on the website, indicating interest by patients and GPs in the content, although these groups would not be the exclusive users of the site (eg researchers may also access it). Better indicators of uptake would be:

• number of individuals ringing the surgery access free telephone number;
• number of individuals contacting the Waiting Time Coordinators and/or Patient Access Coordinators at individual hospitals, the number and types of requests made for assistance; and
• the outcomes of these requests eg no change to access, change to access at same hospital as originally booked in, change to access via a change of hospital, change to access via a change of specialist doctor

Results of evaluation

In the period January to September 2007, the average number of hits on the website varied between 5000 and 5500 per month.

Between January and September 2007, 827 assisted calls were made to the NSW Health Survey Access line.

No information is available about the number of individuals contacting the Waiting Time Coordinators and/or Patient Access Coordinators at individual hospitals, the number and types of requests made for assistance or the outcomes of these requests.

Expected outcome

This policy relies on the use of a website and associated support personnel within hospitals. Therefore, meeting the objectives will require GPs and patients being aware of the existance of these tools. It is not clear that systematic means have been employed to inform GPs and patients about the existance of these tools. If they are used, it is likely that they will have a marginal effect on access to care; GPs or patients may not wish to change either doctors or hospitals or (in case of people living outside major metropolitan areas) may not be able to. One reason that such schemes have not been highly publicised is that the health departments may not wish to raise expectations of patients and/or GPs to a level which they could not meet.

Such schemes are likely to have a marginal impact on costs; there will be increased costs associated with the employment of additional staff to obtain the information necessary for the maintenance of the website and for the salaries of Waiting Time Coordinators and/or Patient Access Coordinators (if they are additional employees). But these costs are low compared with the other costs associated with addressing waiting times and lists ie increasing the availability of operating rooms with the associated staff costs (including specialists doctors and nurses, diagnostic equipment and other costs etc). This initiative is likely to have a marginal effect on access, but, together with associated efforts, may have a greater impact.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

see above

References

Sources of Information

McGarry A. "Online guide for surgical patients". The Australian, August 14th, 2007

NSW Hospital Waiting Times. www.health.nsw.gov,au/waitingtimes Accessed 12th September 2007.

Author/s and/or contributors to this survey

Haas, Marion

Empfohlene Zitierweise für diesen Online-Artikel:

Haas, Marion. "Public information about waiting times". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/au/a10/5