Waiting times for elective surgery
Long waiting times for elective (non-urgent) surgery have been a longstanding issue in many European countries dating back well before the pandemic, but the disruption of elective care during the pandemic exacerbated waiting times as many non-urgent interventions were suspended, generating more backlogs of patients on waiting lists. Long waiting times generate dissatisfaction for patients because the health benefits from treatment are postponed, patients can experience pain and discomfort while waiting, and the wait may worsen health outcomes for patients before and after the intervention.
The data presented in this section focus on waiting times for three high-volume surgical procedures: cataract surgery, hip replacement and knee replacement. They review the experience of patients who have been treated after waiting for a certain period of time and those who were still on the waiting lists. In several countries, the waiting times for patients still on waiting lists have increased much more than for those who were treated.
Looking at the situation just before the pandemic, the mean waiting times for people who had a cataract surgery in 2019 varied widely, from about 40 to 60 days in Hungary, the Netherlands, Denmark and Italy, to over 200 days in Poland and 250 days in Estonia (Figure 7.28, left panel). In 2020, the mean waiting times for patients treated increased slightly in Hungary, the Netherlands, Spain, Finland and Norway, while it remained stable in Italy, Sweden and Portugal, and came down in Estonia but from very high levels. For patients still on waiting lists, the proportion who had been waiting for over three months increased in all countries in 2020, with the exception of Portugal and Poland. The increase was particularly marked in Hungary, Spain and Ireland (Figure 7.28, right panel).
For hip replacement, the mean waiting times for patients treated before the pandemic in 2019 ranged from 45 to 85 days in Denmark, the Netherlands, Lithuania, Italy and Finland, to 300 days in Poland and over 400 days in Estonia (Figure 7.29, left panel). During the first year of the pandemic, waiting times for patients who got a hip replacement increased markedly in Lithuania and to a lesser extent in the Netherlands, Sweden, Norway and Estonia. For patients still on the waiting lists, the proportion waiting for a hip replacement for over three months increased in all countries in 2020, and particularly in Sweden, Spain, Ireland, Hungary and Portugal (Figure 7.29, right panel).
Regarding knee replacement, the cross-country variations in waiting times are fairly similar to the variations for hip replacement both before and after the pandemic, although in most countries the waiting times are generally longer for a knee than a hip replacement. The mean waiting times to get treatment in 2020 increased greatly in Lithuania and to a lesser extent in the Netherlands, Sweden, Norway, Spain and Portugal, while it remained stable but a very high level in Estonia (Figure 7.30, left panel). For patients still waiting for a knee replacement, the proportion waiting for more than three months increased in all countries, and in some cases quite markedly (Figure 7.30, right panel).
Many EU countries have taken actions to address the backlogs and longer waiting lists for elective care that were generated by the disruption of services during the pandemic. Most of these policies focus on increasing surgical activities supported through additional funding in countries like Finland, Ireland, Italy, Lithuania, Portugal and Slovenia (see Chapter 2 for further discussion on national strategies to reduce backlogs).
Two different measures of waiting times are presented in this section: 1) from the time that a specialist adds a patient to the waiting list for an operation to the time that the patient receives the operation; 2) the waiting times for patients who are still on the waiting lists at a given point in time. Waiting times for the first measure are reported as the mean number of days, while the second measure is reported as a proportion of those who have been waiting for over three months.
The data come from administrative databases. The management of administrative data varies across countries. In some countries, patients who refuse on several occasions to receive the procedure are removed from the list, while they continue to be kept on the list in other countries (e.g. Estonia).
