Waiting Time Prioritisation for Public and Private Providers: Evidence From Hip Replacement Surgery

Abstract

Waiting times for planned health care treatments have been increasing in England and other OECD countries. One policy to reduce the impact of waiting times on patients' health is for doctors to prioritise patients according to their health status. This study tests the extent to which publicly-funded patients in poorer health are prioritised on the list, and whether prioritisation differs between public and private providers. We use hospital administrative data in 2015–2021 on hip replacements in England. Our results provide evidence of inpatient waiting-time prioritisation (from specialist addition to list to admission for surgery) based on pre-operative health with a difference of at least 15 days between patients with lowest and highest pre-operative health. The gradient becomes steeper as waiting times increase, and much steeper during COVID-19. While outpatient waiting times (from referral to specialist visit) comprise a substantial proportion of total time waited (inpatient plus outpatient), we find limited evidence of outpatient waiting time prioritisation. Differences in inpatient waiting-time prioritisation between public and private providers are mostly due to different casemix and shorter average waiting times by private providers. We also simulate the effect of prioritisation policies that reduce inpatient waiting times for patients with low pre-operative health by 20% while simultaneously increasing it for those with high pre-operative health. We find that these policies could generate health gains of 183 QALYs in a given year. We conclude that there is scope for improving prioritisation of patients on the waiting list.