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Do maximum waiting times guarantees change clinical priorities? A Conditional Density Estimation approach

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  • Silviya Nikolova;
  • Arthur Sinko;
  • Matt Sutton;
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    Abstract

    The level and distribution of patient waiting times for elective treatments is a major concern in publicly-funded health care systems. Strict targets, which have specified maximum waiting times, have been introduced in the NHS over the last decade and have been criticized for distorting existing clinical priorities in scheduling hospital treatment. We demonstrate the usefulness of Conditional Density Estimation (CDE) in the evaluation of the reform using data for Scotland for 2002 and 2007. The CDE approach allows for variation in the e.ects of patients’ characteristics over ranges of the distribution and avoids restrictive assumptions about error distribution and functional form. We find that health providers achieved the target by reducing the waiting times for long-waiting patients at the expense of short-waiting patients. We also document a change in the prioritization between di.erent patient groups with some patient groups benefiting at the cost of others.

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    Bibliographic Info

    Paper provided by HEDG, c/o Department of Economics, University of York in its series Health, Econometrics and Data Group (HEDG) Working Papers with number 12/07.

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    Date of creation: Apr 2012
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    Handle: RePEc:yor:hectdg:12/07

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    Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom
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    Web page: http://www.york.ac.uk/economics/postgrad/herc/hedg/
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    Keywords: health care; waiting times; conditional density estimation;

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    References

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    1. Gravelle, Hugh & Siciliani, Luigi, 2008. "Ramsey waits: Allocating public health service resources when there is rationing by waiting," Journal of Health Economics, Elsevier, vol. 27(5), pages 1143-1154, September.
    2. Donald, Stephen G & Green, David A & Paarsch, Harry J, 2000. "Differences in Wage Distributions between Canada and the United States: An Application of a Flexible Estimator of Distribution Functions in the Presence of Covariates," Review of Economic Studies, Wiley Blackwell, vol. 67(4), pages 609-33, October.
    3. Propper, Carol & Sutton, Matt & Whitnall, Carolyn & Windmeijer, Frank, 2010. "Incentives and targets in hospital care: Evidence from a natural experiment," Journal of Public Economics, Elsevier, vol. 94(3-4), pages 318-335, April.
    4. Sofia Dimakou & David Parkin & Nancy Devlin & John Appleby, 2009. "Identifying the impact of government targets on waiting times in the NHS," Health Care Management Science, Springer, vol. 12(1), pages 1-10, March.
    5. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    6. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June.
    7. Cullis, John G. & Jones, Philip R., 1985. "National health service waiting lists : A discussion of competing explanations and a policy proposal," Journal of Health Economics, Elsevier, vol. 4(2), pages 119-135, June.
    8. Lindsay, Cotton M & Feigenbaum, Bernard, 1984. "Rationing by Waiting Lists," American Economic Review, American Economic Association, vol. 74(3), pages 404-17, June.
    9. Manning, Willard G., 1998. "The logged dependent variable, heteroscedasticity, and the retransformation problem," Journal of Health Economics, Elsevier, vol. 17(3), pages 283-295, June.
    10. Propper Carol & Sutton Matt & Whitnall Carolyn & Windmeijer Frank, 2008. "Did 'Targets and Terror' Reduce Waiting Times in England for Hospital Care?," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 8(2), pages 1-27, January.
    11. Donna B. Gilleskie & Thomas A. Mroz, 2000. "Estimating the Effects of Covariates on Health Expenditures," NBER Working Papers 7942, National Bureau of Economic Research, Inc.
    12. Januleviciute, Jurgita & Askildsen, Jan Erik & Holmås, Tor Helge & Kaarbøe, Oddvar & Sutton, Matt, 2010. "The Impact of Different Prioritisation Policies on Waiting Times: A Comparative Analysis of Norway and Scotland," Working Papers in Economics 07/10, University of Bergen, Department of Economics.
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