Making sense of delays in outpatient specialty care: A system perspective

• Published in: Health policy (Amsterdam) 2010-09, Vol.97 (1), p.44-52
• Main Authors: Rouppe van der Voort, Marc (MBV), van Merode, Frits (GG), Berden, Bart (HJJM)
• Format: Article
• Language: English
• Subjects: Access to health care; Access to healthcare; Ambulatory Care - organization & administration; Ambulatory Care - statistics & numerical data; Clinics; Health administration; Health care; Health Facility Size - organization & administration; Health policy; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand - organization & administration; Health Services Needs and Demand - statistics & numerical data; Hospital outpatient clinics; Hospital outpatient clinics Access to healthcare; Hospitals; Humans; Incentives; Internal Medicine; Interventions; Matching; Medical care; Medical treatment; Medicine - organization & administration; Medicine - statistics & numerical data; Models, Organizational; Policy makers; Supply and demand; Time Factors; Waiting Lists
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2010.02.013

Abstract Objectives To assess whether delays to outpatient specialty care can be solved by improving the way supply and demand are matched, without adding capacity. Methods A systematic review of the interventions applied by 18 clinics using the model of ‘advanced access’ and a statistical analysis of the effects of the interventions on their delays. Results The clinics applied different combinations of interventions aimed at improving the way they match supply and demand, improving the efficiency of the way supply is organised and at reducing unnecessary demand. Fourteen clinics show statistically significant improvements. Two probably significantly improved and two clinics did not. Their access reduced on average 55%, from 47 to 21 days. Conclusions It seems that delays in outpatient specialty care can be solved to a large extend by improving the way supply and demand are matched. Policy makers should analyse whether delays are caused by capacity problems or matching problems. For the latter, it appears more effective to invest in the ability to react then the ability to plan. Policy makers should create incentives for clinics to keep access short and remove incentives that stimulate delays.