Waiting times for elective surgery
Long waiting times for elective (non-urgent) surgery have been a longstanding issue in many European countries as they generate dissatisfaction for patients because the expected benefits of treatments are postponed. The COVID-19 pandemic will likely increase waiting times for many elective surgery, at least temporarily, as non-urgent interventions have often been postponed during the peak of the epidemic.
The data presented in this section focus on 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 list.
The median waiting times for people who received a cataract surgery in 2019 (or 2018) varied from about 30 days in Italy, Hungary and Denmark, to about 150 days in Estonia and 250 days in Poland (Figure 7.27, left panel). The proportion of patients remaining on the waiting list for a period of more than three months during that same year varied from 7% in Hungary to over 85% in Estonia, Poland and Slovenia (Figure 7.27, right panel).
For hip replacement, the median waiting times ranged from 35 to 50 days in Denmark, Hungary and Italy, to 180 days in Poland and 250 days in Estonia (Figure 7.28, left panel). The proportion of patients remaining on the waiting list for more than three months ranged from 25% of all patients in Sweden to 90% or more in Estonia and Slovenia (Figure 7.28, right panel).
The pattern is generally the same for knee replacement, although in most countries the waiting times are slightly longer than for hip replacement (Figure 7.29).
Among the group of countries with relatively short waiting times, Italy has managed to keep waiting times for elective surgery relatively short in recent years despite tight budgetary constraints, and Denmark and Hungary have managed to reduce waiting times through an effective policy mix. Denmark has managed to reduce waiting times over the past decade mainly through the implementation of a waiting time guarantee for patients, initially set at two months from a GP or specialist referral to treatment in 2002, but then reduced to one month in 2007 (OECD, 2020).
Hungary has achieved substantial progress in reducing waiting times for elective surgery in recent years through the implementation of a mix of supply-side measures and better management of demand. One of the main goals of the Hungarian 2014-20 health sector strategy has been to reduce waiting times to less than 60 days for minor surgery (like cataract surgery) and less than 180 days for major surgery (like hip and knee replacement) for all patients across the country. To achieve this goal, the government has adopted new laws and regulations on the management of waiting lists and supported the development of an online waiting list system to monitor the situation in real-time across the country. It also provided additional payments to reduce waiting times in selected clinical areas and hospitals, and encouraged a reallocation of patients from providers with longer waiting times to those with shorter waiting times (OECD, 2020).
Among the group of countries with long waiting times, the median waiting times to get a cataract surgery in Estonia decreased sharply between 2009 and 2014, but then increased again between 2014 and 2019 although it didn’t go back to the very high level of a decade earlier. Recent trends in waiting times for hip and knee replacement are worse, with waiting times increasing to levels exceeding those of ten years ago. In 2018, the Estonian Health Insurance Fund provided an additional EUR 34 million to finance about 140 000 additional treatments with the goal of reducing waiting times for cataract surgery and hip and knee replacement. The increase in surgical activities in 2018 and 2019 led to a reduction in waiting times for cataract surgery and hip replacement, but not for knee replacement (OECD, 2020).
In Poland, waiting times for all three surgical interventions decreased substantially between 2014 and 2018 (latest year available), following the adoption of measures to increase the supply of elective surgery. Until 2018, if the demand for services exceeded what had been budgeted for, elective procedures were rationed through waiting lists and treatments were postponed to the next year. Since 2018, additional funding is provided for additional treatments. Information on waiting times for different treatments in public hospitals are now also more easily accessible to patients through a dedicated website. A growing number of Polish people also purchase a private health insurance to get quicker access to services in private hospitals (OECD, 2020).
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; and 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 in the median number of days. The median is the value which separates a distribution in two equal parts (meaning that half the patients have longer waiting times and the other half shorter waiting times). Compared with the average, the median minimises the influence of outliers (patients with very long waiting times).
The data come from administrative databases. The management of administrative data can vary 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).
References
OECD (2020), Waiting Times for Health Services: Next in Line, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/242e3c8c-en.
Note: For the Netherlands, the data on waiting times is the mean number of days because the median is not available (resulting in an over-estimation compared with other countries). For Norway, waiting times are over-estimated because they start from the date when a doctor refers a patient for specialist assessment up to treatment (whereas in other countries they start only when a specialist has assessed the patient and decided to add the person on the waiting list).
Source: OECD Health Statistics 2020.
Note: For the Netherlands, the data on waiting times is the mean number of days because the median is not available (resulting in an over-estimation compared with other countries). For Norway, waiting times are over-estimated because they start from the date when a doctor refers a patient for specialist assessment up to treatment (whereas in other countries they start only when a specialist has assessed the patient and decided to add the person on the waiting list).
Source: OECD Health Statistics 2020.
Note: For the Netherlands, the data on waiting times is the mean number of days because the median is not available (resulting in an over-estimation compared with other countries). For Norway, waiting times are over-estimated because they start from the date when a doctor refers a patient for specialist assessment up to treatment (whereas in other countries they start only when a specialist has assessed the patient and decided to add the person on the waiting list).
Source: OECD Health Statistics 2020.