A novel methodology to measure waiting times for community-based specialist care in a public healthcare system

Abstract

AbstractBackgroundMonitoring of waiting time (WT) in healthcare systems is essential, since long WT are associated with adverse health outcomes, reduced patient satisfaction and increased private financing.ObjectiveTo develop a methodology for routine national monitoring of WT for community-based non-urgent specialist appointments, in a public healthcare system.DesignObservational historical study using data from computerized appointment scheduling systems of all Health Maintenance Organizations (HMOs) in Israel.Data sourcesData included available appointments for community-based specialists and actual number of visits.The first 50 available appointments from each specialist appointment book were collected throughout December 2018. Five most frequently visited specialties - orthopedics, ophthalmology, gynecology, dermatology and otolaryngology - were included.Data collection/extraction approachWT offered to HMO members (OWT) were calculated for two scenarios: “specific” physician and “any” physician in the clinic’s geographical region. Distribution of OWT was calculated separately for each specialty and geographical region, combined to create the nationwide distribution, and expressed as mean, standard deviation and percentiles.Principal findingsEstimated national median OWT for “specific” physician, ranged from 6 days (ophthalmology) to 13 days (dermatology), with large variation between geographic regions. OWT for “any” physician were 28-50% shorter than for “specific” physician.ConclusionsThis novel method offers a solution for ongoing national WT measurement, using computerized scheduling systems. It integrates patient preferences for physician choice and allows identification of differences between specialties and regions, setting the ground for interventions to strengthen public healthcare systems.