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Room: Congress Hall A
Time: Sat 08:30 AM-09:45 AM

Public Hospital Waiting Times in Australia: An exploration of the determinants of waiting time, preferential treatment and the impact on demand for private health insurance

Chair: Nazmi Sari

Session Description

Reducing public hospital waiting times, both in emergency departments and for elective procedures, is a central issue in health care systems with a dominant public sector. In Australia, subsidies to private health insurance and increased expenditures to shorten waiting times both aim to ease pressure on the public hospital system. However there is no empirical evidence to support the relative equity or efficiency merits of alternative policies. There is a wealth of under-utilised administrative inpatient data in Australia, including waiting times, that is essential for untangling complex health care decisions, that has not previously been used for this purpose. The papers in this session use a range of analytical techniques to combine patient level administrative data and survey data to analyse the determinants of waiting times and explore the implications for the equity and efficiency of the health system.
There is widespread concern that using price to ration health care access has detrimental equity implications. However, there is limited investigation to date of the equity outcomes of rationing by waiting times. Paper 1, “Non-clinical determinants of waiting times for elective admissions in NSW public hospitals” focuses on equity impacts of administered waiting lists. Decomposition analyses are used to identify dimensions of discrimination.
Most of the literature on the impact of waiting times on the demand for private health insurance relies on proxies for waiting time, usually at a regional level. Access to individual waiting time data for public inpatient admissions allows an exploration of the association between insurance demand and different proxies of waiting times. Paper 2, “The demand for private health insurance: do waiting lists or waiting times matter?” examines the sensitivity of the influential Besley et al (1999) findings to the use of waiting times or waiting lists and varying levels of spatial aggregation.
In paper 3, “Expected waiting times and the decision to buy private health insurance”, models of expected individual waiting times are estimated using linked public hospital inpatient and waiting time data. The model is used to augment survey data to estimate the impact of expected waiting times on the decision to buy private health insurance. This is the first study to explore this relationship at the individual level.
In Australia a majority of public hospital admissions come via emergency departments where constraints on resources, both available beds and staff, can lead to long waits and adverse events, with congestion-related impacts on planned admissions as well. Paper 4, “Access block and overcrowding in Emergency Departments: a correlated hazard approach” undertakes an analysis of waiting in emergency departments using a multi-episode process. The analysis reveals how different patient and ED level characteristics affect ED progression at each stage of the process.

Session Organizer: Elizabeth Savage (University of Technology, Sydney)

Presentations

1. Access block and overcrowding in Emergency Departments: a correlated hazard approach

   Presenter: Anthony Harris (Monash University)

2. Expected waiting times and the decision to buy private health insurance

   Presenter: Elizabeth Savage (University of Technology, Sydney)

3. Non-clinical determinants of waiting times for elective admissions in NSW public hospitals

   Presenter: Glenn Jones (Macquarie University)

4. The demand for private health insurance: do waiting lists or waiting times matter?

   Presenter: Meliyanni Johar (University of Technology, Sydney)