The impact of waiting time on health gains from surgery: Evidence from a national patient reported outcomes dataset

Reducing waiting times has been a major focus of the English National Health Service (NHS) for many years but little is known about the impact on health outcomes. The collection of data on Patient Reported Outcome Measures (PROMs) for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of PROMs before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1 million and £11.5 million respectively.