title: Waiting time prioritisation: Evidence from England.
abstract: A number of OECD countries have introduced waiting time prioritisation policies which give explicit priority to severely ill patients with high marginal disutility of waiting. There is however little empirical evidence on how patients are actually prioritised. We exploit a unique opportunity to investigate this issue using a large national dataset with accurate measures of severity on nearly 400,000 patients. We link data from a national patient-reported outcome measures survey to administrative data on all patients waiting for a publicly funded hip and knee replacement in England during the years 2009-14. We find that patients suffering the most severe pain and immobility have shorter waits than those suffering the least, by about 24% for hip replacement and 11% for knee replacement, and that the association is approximately linear. These differentials are more closely associated with pain than immobility, and are larger in hospitals with longer average waiting times. These result suggests that doctors prioritise patients according to severity even when no formal prioritisation policy is in place and average waiting times are short.
authors.affiliation: Centre for Health Economics, University of York, UK. Electronic address: nils.gutacker@york.ac.uk.
authors.forename: Nils
authors.initials: N
authors.lastname: Gutacker
authors.affiliation: Department of Economics and Related Studies, University of York, UK.
authors.forename: Luigi
authors.initials: L
authors.lastname: Siciliani
authors.affiliation: Centre for Health Economics, University of York, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D001182:Arthroscopy / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006292:Health Priorities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016012:Poisson Distribution; D013997:Time Factors; D014850:Waiting Lists
keywords: England; Patient-reported outcome measures; Prioritisation; Severity; Waiting times