Waiting times for elective surgeries in Austria: A question of transparency

Presenter: Markus Kraus, Institute for Advanced Studies (IHS)

Abstract

Objective:
In many countries, waiting times for elective surgeries are a serious threat to ensuring equal access to healthcare. In the course of an encompassing OECD study (Siciliani and Hurst 2003), Austria reported not to have any noteworthy waiting times for elective surgeries. This is contrasted by repeated reports from both patients and authorities that there are waiting times for ophthalmologic and orthopaedic operations. The objective of this study is to shed more light on the issue of waiting times for elective surgeries in Austria.

Methodology:
The lack of an official system of monitoring waiting times and the reluctancy of hospitals to allow access to patient data at first renderes the topic very elusive. To draw a clearer picture of waiting times of elective surgeries, we therefore performed several mutually complementary investigations. We interviewed all Austrian hospital companies, the patient representatives of Austria’s nine regions and the Ministry of Health. Furthermore, we conducted a retrospective questionnaire-based survey of waiting times for orthopaedic operations in rehabilitation centres, being the only viable source to obtain actual patient based data, and we analysed the Austrian Health Survey 2006 in terms of waiting times.

Result:
Our investigations confirmed the existence of waiting times for elective surgeries and allowed their quantification. There are large differences in waiting times with respect to the operation type (cataract surgery, hip joint replacement, knee joint replacement) between as well as within regions. According to
- all hospital companies, waiting times for cataract surgeries as well as for hip and knee joint surgeries exist. However, only the Styrian and Upper Austria hospital company were able to provide exact data. In Styrian hospitals patients wait on average 142 days for a cataract surgery, 108 days for a hip joint endoprothesis and 172 days for a knee joint endoprothesis whereas patients in Upper Austrian hospitals wait 84 days, 72 days and 149 days for these surgeries.
- the retrospective questionnaire-based survey in rehabilitation centres the average waiting time for hip joint replacement is 70 days and for knee joint replacement is 203 days.
- the Austrian Health Interview Survey 2006 patients wait on average 102 days for cataract operations, 97 days for hip joint operations and 78 days for knee joint operations.

We attribute this situation partly to lacking transparency of waiting times. Consequently, specialists and patients do not know the length of waits in a particular hospital. There is far too little transparency and coordination in Austria to optimise waiting times. International examples demonstrate that transparency and coordination are possible, e.g. the websites of the UK Department of Health and of Health Canada offer a wealth of information about waiting times for all common operations.

Furthermore we found that some patients in our survey were offered shorter waiting times in exchange for informal payments or private practice visits.

In view of what has been said there is urgent need for action to improve transparency of waiting times and thus giving patients an informed choice to attend hospitals with lower waiting times.