In response to my post yesterday, on delays in the MS path and comments from you, today’s post is an attempt to explain the reason for the waiting game (even in the USA) and its potential consequences. I have also included a survey to explore what are acceptable delays for you as individuals with MS.
The following perspective on why healthcare systems build-in waiting times into their services is self-explanatory. If you want to optimise the use of resources and maximise profits you need waiting lists. Waiting lists means you maximise the use of your staff and healthcare infrastructure. Healthcare is big business and has to generate income and return on investment. The NHS is no exception, but due to under-investment the NHS tends to push this policy to the extreme and as a result there are major consequences for people with MS and other diseases. The NHS tries to address the latter issues by using triage systems for prioritising urgent problems, for example the 2-week target for cancer.
Healthcare provider’s who have no waiting times have to invest in extra, or spare, capacity to meet fluctuating demand. Excess capacity costs money and these providers simply charge more for their services. This is why the Mayo Clinic and the Cleveland Clinic, who were mentioned in comments yesterday, charge more than other providers. The extra charges pay for spare, or idle, capacity that these and other institutions have. So in reality waiting lists are dictated by finances.
Ryu & Lee. The Waiting Game — Why Providers May Fail to Reduce Wait Times. N Engl J Med 2017; 376:2309-2311.
…. When patients wait weeks or months for physician’s appointments, bad things happen. Some adverse consequences are emotional: patients become anxious and even angry. Some are clinical, such as medical issues that worsen, especially if patients don’t show up when their appointments finally roll around.
….. But other consequences of long waits are financial, and they help explain why most health care providers have dragged their feet in cutting waiting times for all types of visits, but particularly for specialty care. Redesigning care to reduce waits requires investing in systems, may reduce revenue, and will irritate physicians who like to control their schedules.
…… Understanding the financial dynamics of the “Waiting Game” can clarify the strategic context in which waiting times are most likely to fall. It also sheds light on the implications of fee-for-service versus value-based payment methods for the way practices and systems approach the access conundrum.
…… Waiting has emotional effects on patients. Uncertainty causes anguish, particularly in patients concerned that disease may be progressing and intervention opportunities may be lost. Other variables such as teamwork, communication, and empathy are more powerful drivers of patients’ likelihood of recommending clinicians to others, but no one likes to wait. Data reveal a dose–response effect: the longer the wait, the lower patients’ satisfaction with care. When patients have to wait weeks for a specialist appointment, their satisfaction falls off a cliff.
…… Given this trend, it’s ironic that physicians often cite long waiting times as evidence of their excellence. Physicians and practice administrators rationalize delays by noting that they’re already working flat out and demand for their services is simply too great. Most deny that they like having long waiting lists, but when their lists shorten they worry that competitors are taking their business. In a fee-for-service environment, physicians dread having open slots in their schedules, bringing in no revenue while expenses mount.
…… The longer patients wait for their appointments, the greater the chance that they won’t show up (see graph Relationship between Waiting Times for Appointments and No-Show Rates.). No-shows are as problematic from a fiscal perspective as unfilled schedule slots. To reduce their impact, practices often “double-book” patients, which makes volume surge when all patients show up. The result may be chaos, with angry patients waiting an hour or more and dispirited clinicians and staff trying to both appease and care for them.
…… In short, it requires recognizing that the Waiting Game provides rewards for letting patients wait, or at least makes investments in reducing waits less attractive than other uses of providers’ resources. But as providers compete on their ability to improve value for patients, the Waiting Game should be subsumed under the more strategic challenges of attracting patients and meeting their needs as efficiently as possible.