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Queueing for coronary surgery during severe supply-demand mismatch in a Canadian referral centre: A case study of implicit rationing

Author

Listed:
  • Naylor, C. David
  • Levinton, Carey M.
  • Wheeler, Susan
  • Hunter, Linda

Abstract

Queues for in-patient surgery are commonplace in universal health care systems. Clinicians and hospitals usually manage these waiting lists with informal criteria for determining patient priority--a form of implicit rationing. To understand the workings of implicit rationing by queue, we took advantage of a natural experiment in the Canadian province of Ontario. Unprecedentedly severe supply-demand mismatch led to long waiting lists for coronary surgery [CABS] in Ontario during 1987-1988. The crisis was resolved by increased funding and widespread adoption of a multifactorial clinical index for patient priority that was developed by an expert panel in 1989. Thus, we audited randomly chosen charts of patients who underwent coronary angiography at four Toronto hospitals during the crisis period, and calculated urgency scores for each case based on the multifactorial index. From 413 charts, 193 eligible patients were identified who proceeded to CABS. Waiting times did correlate with urgency ratings (r = 0.42, P

Suggested Citation

  • Naylor, C. David & Levinton, Carey M. & Wheeler, Susan & Hunter, Linda, 1993. "Queueing for coronary surgery during severe supply-demand mismatch in a Canadian referral centre: A case study of implicit rationing," Social Science & Medicine, Elsevier, vol. 37(1), pages 61-67, July.
    • Handle: RePEc:eee:socmed:v:37:y:1993:i:1:p:61-67
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    Citations

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    Cited by:

    1. Arnesen, Kjell E. & Erikssen, Jan & Stavem, Knut, 2002. "Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management," Health Policy, Elsevier, vol. 62(3), pages 329-341, December.
    2. Roger Feldman & Felix Lobo, 1997. "Global Budgets and Excess Demand for Hospital Care," Health Economics, John Wiley & Sons, Ltd., vol. 6(2), pages 187-196, March.
    3. Walton, Nancy A. & Martin, Douglas K. & Peter, Elizabeth H. & Pringle, Dorothy M. & Singer, Peter A., 2007. "Priority setting and cardiac surgery: A qualitative case study," Health Policy, Elsevier, vol. 80(3), pages 444-458, March.
    4. Rotstein, Dalia L. & Alter, David A., 2006. "Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists," Social Science & Medicine, Elsevier, vol. 62(12), pages 3157-3160, June.

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