A review of waiting times policies in 13 OECD countries

This chapter reviews various policy tools that countries have used to tackle excessive waiting times in 13 countries: Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden and the United Kingdom. The most common policy is some form of maximum waiting time guarantee. Increasingly, such guarantees are backed with targets set for providers and sanctions if these targets are not met. The guarantees often go hand-in-hand with choice, competition and an increase in supply (in the public and/or the private sector). These policies have generally been successful in bringing down waiting times. In contrast, most attempts to increase supply temporarily in order to decrease waiting times have had only a limited effect. A better approach may be to condition increases in supply on simultaneous reductions in waiting times. Demand-side policies attempt to define more rigorous clinical thresholds for treatment. However, it has proved difficult to implement such thresholds. The most promising approaches link waiting time guarantees to different categories of clinical need, also referred to as waiting time prioritisation. An alternative demand-side approach is to encourage private health insurance to shift demand from the public to the private sector, though this has generally not proven successful in reducing waiting times.