Waiting time for scheduled outpatient specialist consultations by access pathway in public hospitals in Ecuador

Objective: To quantify waiting time in days for scheduled outpatient specialist consultations and to compare waiting time between standardized and non-standardized access pathways in Ecuadorian public hospitals. Methods: We analyzed hospital-based survey data from Ecuadorian public hospitals, restricted to adults attending a scheduled outpatient specialist consultation (n = 4,436). Emergency care, unscheduled urgent visits, procedures, and follow-up visits were excluded by design. Access pathway was classified from participants’ self-report as standardized (institutional or system-based) or non-standardized (informal or non-system-based). Waiting time, defined as the number of days between obtaining the appointment and attending the consultation, was compared using the Mann–Whitney U test. Sociodemographic correlates of non-standardized access were examined using adjusted logistic regression, and adjusted median differences were estimated using quantile regression (τ = 0.50). Effect modification by specialty referral requirement was assessed in a single median regression model using an interaction between access pathway and referral-requirement stratum. Results: Non-standardized access was associated with shorter waiting times than standardized access. In median regression adjusted for sociodemographic covariates, specialty, and hospital, with hospital-clustered inference, non-standardized access was associated with a 3.6-day shorter conditional median waiting time (95% CI −6.2 to −1.0). Adjusted stratum-specific contrasts were −7.9 days (95% CI −13.7 to −2.1) in direct-access specialties and −3.1 days (95% CI −5.9 to −0.2) in referral-required specialties; however, the interaction between access pathway and referral-requirement stratum was not statistically significant (p = 0.136). Conclusion: Among patients who attended a scheduled outpatient specialist consultation in Ecuadorian public hospitals, non-standardized access was associated with shorter waiting times. Although the adjusted point estimate was larger in direct-access specialties, the formal interaction test did not provide clear evidence that the association differed according to specialty referral requirement.