|Implemented in this survey?|
A number of States in Australia are providing information to the public about average waiting times for elective procedures. The policy is being publicised as a means for GPs and their patients to try to access surgery faster. In additon, elective surgery coordinators have been employed to improve scheduling and waiting list practices, including ensuring that individual patients are on one list and to investigate ways of reducing postponement of surgery.
The stated aims of this policy are to:
Characteristics of this policy
The data are updated quarterly and relate to the previous 12 months period. Information is also provided about the categories of clinical priority by which patients are categorised. Information is provided for doctors about the completeness of the data, indicating that it provides infomation on public and private booked surgical and medical inpatients in public hospitals in NSW. The information about specialist doctors does not include their work in the private sector.
Governments, health departments, hospitals and specialist doctors all have incentives to be seen to improve waiting times because the media often report information about this and the public see this as an important issue. Thus, the incentives for the health system are to increase access to clinically relevant care and to decrease complaints about waiting times.
In recent years, most State governments have provided additional funding to reduce waiting times by increasing the staff available and scheduling more surgical sessions per day and per week. They have now provided funding for the coordinators whose task it will be to improve the quality of the services in other ways, ie to reduce the confusion around multiple waiting lists and reduce the number of postponed procedures.
Patients, general practitioners, specialist doctors
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
This policy has the potential to increase access to elective procedures for some patients. However, its impact is dependent on a number of factors:
Waiting times and the length of waiting lists for elective procedures have long been a sensitive political issue in Australia. In recent times, all State and Territory governments have provided additional funding over a sufficiently long period that the problem has been reduced to a large extent. This has led to a situation where the governments are relatively comfortable publishing information about the waiting times for procedures by hospital and specialist doctor.
|Implemented in this survey?|
Publishing information about the relative quality of care (including access to care) is common in the health systems of developed countries. This type of policy is based on the notion that additional information will be beneficial. In addition, the advent of the World Wide Web has increased the ability of many people to access such information. The development of such information is a consequence of increased expectations by the public that such information will be available and the availability of the Web to provide such information. In Australia, the Council of Australian Governments (COAG), and the Australian Health Ministers Advisory Council (AHMAC) where both State/Territory and Federal government ministers and officials meet regularly, are forums at which such developments are discussed and approved, and if funded, implemented nationally.
The approach of the idea is described as:
The general idea of information being made available and work being done to streamline waiting lists and reduce postponements is supported. All governments recognise the importance of reducing waiting lists and times and have succeeded to some extent. Bureaucrats, having succeeded in persuading governments to fund sufficient surgery to decrease the number of people on the lists and the time they wait, have now persuaded them to fund coordinators to try and deal with the other troubling aspects of elective surgeries; muliple, duplicated lists and postponement of surgery (which is commonly caused by emergencies which have priority). However, the Australian Medical Association (AMA) has questioned the usefulness of the information to people who do not have a medical background, saying that the numbers do not indicate waiting times for triage or assessment.
|State governments||very supportive||strongly opposed|
|Health bureaucrats||very supportive||strongly opposed|
|Opinion leaders||very supportive||strongly opposed|
|State governments||very strong||none|
|Health bureaucrats||very strong||none|
|Opinion leaders||very strong||none|
The implementation of this policy is the responsibility of State/Territory health departments together with local (eg AHS) officials. It is necessary for patients and/or GPs to know about the system, have access to the Workd Wide Web to be able to use it and to choose to adopt the advice contained in the system.
There is no formal mechanism for evaluation. However, it would be possible to know how many "hits" there have been on the website, indicating interest by patients and GPs in the content, although these groups would not be the exclusive users of the site (eg researchers may also access it). Better indicators of uptake would be:
In the period January to September 2007, the average number of hits on the website varied between 5000 and 5500 per month.
Between January and September 2007, 827 assisted calls were made to the NSW Health Survey Access line.
No information is available about the number of individuals contacting the Waiting Time Coordinators and/or Patient Access Coordinators at individual hospitals, the number and types of requests made for assistance or the outcomes of these requests.
This policy relies on the use of a website and associated support personnel within hospitals. Therefore, meeting the objectives will require GPs and patients being aware of the existance of these tools. It is not clear that systematic means have been employed to inform GPs and patients about the existance of these tools. If they are used, it is likely that they will have a marginal effect on access to care; GPs or patients may not wish to change either doctors or hospitals or (in case of people living outside major metropolitan areas) may not be able to. One reason that such schemes have not been highly publicised is that the health departments may not wish to raise expectations of patients and/or GPs to a level which they could not meet.
Such schemes are likely to have a marginal impact on costs; there will be increased costs associated with the employment of additional staff to obtain the information necessary for the maintenance of the website and for the salaries of Waiting Time Coordinators and/or Patient Access Coordinators (if they are additional employees). But these costs are low compared with the other costs associated with addressing waiting times and lists ie increasing the availability of operating rooms with the associated staff costs (including specialists doctors and nurses, diagnostic equipment and other costs etc). This initiative is likely to have a marginal effect on access, but, together with associated efforts, may have a greater impact.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
McGarry A. "Online guide for surgical patients". The Australian, August 14th, 2007
NSW Hospital Waiting Times. www.health.nsw.gov,au/waitingtimes Accessed 12th September 2007.