Authors' objectives:

This study is aimed at quantifying and describing the situation of waiting lists in Europe, as well as the different strategies or policies developed or proposed to face this issue.

Authors' recommendations: While in Europe different health care models co-exist with different organisation, financing and service delivery systems, waiting lists have been found in different countries. In all the countries, explicit and/or implicit rationing systems are present, including waiting lists. Countries with national health systems were found to be more explicit and transparent at quantifying waiting lists. Surprisingly, those countries where the general practitioner is not the first step to reach specialised care, or where co-payments per hospital admission are performed, seem to have no waiting lists, or at least there is no information available to this respect. It was found that despite the differences between health care systems, those medical specialities with more waiting lists are common in most countries: traumatology/orthopaedics, otorhinolaryngology, ophthalmology, vascular surgery, general surgery and plastic surgery. The main conclusions reached in this report are the lack of uniformity among countries regarding the definition of criteria to enter in the waiting list; how to express the waiting time, and what is the reference population. The proposals identified in the European countries can be classified in three large groups: 1) proposals to reduce the size of the waiting list (increasing the system's capacity (offer); financing private sector treatments; use of health care in other countries; decrease/restriction of the offer; decrease / restriction of the demand; modification of legal barriers); 2) proposals to reduce the waiting time (increasing the effectiveness of health care and improving the co-ordination between primary care and specialised care levels; favouring day surgery or alternative procedures; establishment of guaranteed times; organisational measures aiming at improving efficiency), 3) proposals to rationalise waiting lists (creating or improving waiting list information systems; analysis and publication of waiting list and global waiting time data, for each provider; establishment of waiting list prioritisation times; specific policies regarding the providers' financing system; mid- and long-term integrating policies; impact measurement assessment). The most promising or successful of all the policies aiming at dealing with waiting lists described above are those considering both short, mid and long term measures as a whole; acting both on demand and offer aspects; leaning on assessed needs; explicit and transparent; having the professionals' involvement; based on the citizens' active, bi-directional participation, and covering all the instances of health care. However, before applying any proposal aimed at waiting lists, accurate, transparent information on this particular is needed, by means of explicit, systematic and consensuated information systems. Finally, in front of the limited resources for distribution, the approach to the issue of waiting lists requires a more global perspective and an multi-sectorial politic commitment. In other words, how much resources will be invested in health care compared to the remaining social needs.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)