The impact of government targets on waiting times for elective surgery: new insights from time-to-event analysis

Sofia Dimakou (), David Parkin (), Nancy Devlin and John Appleby ()
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Sofia Dimakou: Department of Economics, City University, London, http://www.city.ac.uk/economics/
John Appleby: King’s Fund, London, http://www.kingsfund.org.uk/about_us/whos_who/john_appleby.html

No 06/05, City University Economics Discussion Papers from Department of Economics, City University, London

Abstract: Waiting is an important means by which health care is rationed in the NHS. Waiting times for elective surgery are a key policy and political concern. The principal policy response has been to introduce waiting time targets against which performance is measured and rewarded. As waiting times fall, interest has grown in questions such as: How have behavioural responses to the targets influenced the distributions of waiting times? Does the probability of admission for any given waiting time remain constant? To what extent are clinical distortions evident in the pattern of admissions? Can variations in waiting times be explained by clinical, patient or provider-level characteristics? This paper investigates these questions using time-to-event techniques applied to NHS waiting time data for three specialties (general surgery, trauma & orthopaedics and ophthalmology) during 2001/02 and 2002/03. The analysis generates some powerful insights; estimation of the survival functions reveals considerable variations in waiting times between different specialties, operative procedures and trusts. Hazard rates vary over time and notable peaks -increased probabilities of admission- coincide with targets and do change when targets change. Finally, patient characteristics such as age, sex or ethnicity do not influence the time they have to wait while classification as NHS/private patient and day surgery play an important role.

New Economics Papers: this item is included in nep-hea
Date: 2006-07
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