Seventeen broad interventions that aimed to reduce waiting lists or waiting times for health services in Ireland have been identified and defined in a paper produced by the Department of Health.
The views presented in the paper, “Acute Hospital Waiting Lists and Times: An Umbrella Review on the Effectiveness of Interventions to Reduce Waiting Lists and Times for Elective Care,” do not represent the official views of the Minister for Health.
The interventions can be mapped as follows:
- Severity thresholds for GP referral for specialist consultation or addition to the waiting list (prioritisation guides, improving referral processes) and private coverage that address waiting list inflows/demand.
- Public capacity (increasing capacity, dedicated elective facilities), funding extra activity within existing capacity (public, private or abroad), productivity interventions, and provider payment mechanism that address waiting list outflows/supply.
- Waiting time guarantees (WTG), WTG with provider incentives, and WTG with patient choice that address demand and supply interaction.
The paper says that whether an intervention was effective depended not just on whether it reduced inflows or increased outflows but ultimately on whether it reduced the waiting list or wait times.
To reduce the risk of unfounded conclusions Cochrane EPOC guidelines recommends the use of four types of study designs when judging the effects of health system interventions – randomised trials, non- randomised trials, controlled before-after studies and interrupted time series studies.
The paper said, “Four literature reviews identified through our systematic search highlighted that there are a limited number of studies available that test how an intervention changes the size of waiting lists or wait times. This makes forming firm conclusions on the effect of specific interventions on the size of waiting lists or wait times difficult. In addition, only one of these reviews followed recommended best practice guidelines in assessing the effectiveness of interventions.
- The reviews pointed to limited evidence on the effectiveness of interventions. However, those with at least some level of supportive evidence, albeit caveated, were:
- Long-term investment in increasing capacity in the public system.
- Funding extra public activity within existing capital stock if sustained and contingent on both activity and with waiting list reductions, and funding of commissioning under certain conditions.
- Productivity measures such as raising the use of day surgery, improved surgical pathways, management of waiting lists.
The paper says previous literature reviews noted that there were a limited number of studies that tested the effect of interventions on waiting list size or wait times, so there was an opportunity to contribute not only to Ireland’s but also to the international evidence base.
“The Department of Health should work with the Health Research Board (HRB) to support research in this priority area.
“Previous literature reviews note that there is a risk that increases in hospital capacity could be partially offset by an increase in inappropriate referrals, tests, and procedures. Over time it is important to ensure adherence to appropriate severity thresholds for referrals from general practice to specialist consultation, and effective provision of direct feedback at the level of practice on unusual referral rates and/or conversion rates.”
The paper says that despite waiting lists for elective care being of high to medium priority across most OECD/EU countries, collated evidence on international approaches to reducing waiting lists and times was limited.
“A useful source, and probably the best for policy makers, are OECD reviews and working papers that are produced periodically. Nevertheless, it is important to expand on the evidence base especially in relation to the three areas identified below.
The Department of Health should work with international agencies (such as the OECD and the Observatory) to develop regularly updated (a) online repository of in-depth analysis of specific interventions or policy approaches adopted internationally, (b) literature review of good-quality primary evidence on the effect of interventions on waiting list size and wait times and (c) thematic reviews on interventions to address the determinants of waiting lists such as public capacity, funding extra activity, productivity, and severity thresholds.
Murphy, R and Kelly, A.
(2023). Acute Hospital Waiting Lists and Times: An Umbrella Review on the Effectiveness of Interventions to Reduce Waiting Lists and Times for Elective Care
Waiting Lists Series: Report No. 2. Department of Health