title: The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients.
abstract: BACKGROUND
  Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients.
  
  
  METHODS
  A questionnaire survey was conducted among 257 former patients (82 with varicose veins, 86 with inguinal hernia, and 89 with gallstones), 101 surgeons, 95 occupational physicians, and 65 GPs. Judgements on acceptable waiting times were assessed using vignettes of patients with varicose veins, inguinal hernia, and gallstones.
  
  
  RESULTS
  Participants endorsed the prioritisation of patients based on clinical need, but not on ability to benefit. The groups had significantly different opinions (p < 0.05) on the use of non-clinical priority criteria and on the need for uniformity in the prioritisation process. Acceptable waiting times ranged between 2 and 25 weeks depending on the type of disorder (p < 0.001) and the severity of physical and psychosocial problems of patients (p < 0.001). Judgements were similar between the survey groups (p = 0.3) but responses varied considerably within each group depending on the individual's attitude towards waiting lists in health care (p < 0.001).
  
  
  CONCLUSIONS
  The explicit prioritisation of patients seems an accepted means for reducing the overall burden from waiting lists. The disagreement about appropriate prioritisation criteria and the need for uniformity, however, raises concern about equity when implementing prioritisation in daily practice. Single factor waiting time thresholds seem insufficient for securing timely care provision in the presence of long waiting lists as they do not account for the different consequences of waiting between patients.
authors.affiliation: Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands. j.p.oudhoff@bham.ac.uk
authors.forename: Jurriaan P
authors.initials: JP
authors.lastname: Oudhoff
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
authors.forename: Martin
authors.initials: M
authors.lastname: Rietberg
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D001291:Attitude of Health Personnel; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005194:Family Practice / Q000941:ethics; D005260:Female; D042882:Gallstones / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D013502:General Surgery / Q000941:ethics; D015276:Health Care Rationing / Q000941:ethics* / Q000379:methods; D006292:Health Priorities / Q000145:classification* / Q000941:ethics; D006297:Health Services Accessibility / Q000941:ethics; D006552:Hernia, Inguinal / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009787:Occupational Medicine / Q000941:ethics; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection / Q000941:ethics; D012935:Social Justice; D011795:Surveys and Questionnaires; D013995:Time; D014648:Varicose Veins / Q000145:classification / Q000175:diagnosis / Q000601:surgery; D014850:Waiting Lists