Are waiting times and length of stay connected? Theoretical underpinnings and empirical results

The English Government implemented and stringently enforced maximum waiting time (MWT) targets to tackle long waiting times for elective surgery. We consider their impact on patient prioritisation for treatment based on expected hospital length of stay. We demonstrate that prioritisation based on expected length of stay can significantly decrease average waiting times. We test whether hospitals have adopted such behaviour using data for four large volume elective procedures and 1998 – 2011 period which saw the progressive tightening of targets and their subsequent relaxing after 2010. Our analysis suggests that, following the introduction of the MWT regulatory framework, patients with longer expected hospital stay waited longer for treatment. As coronary procedures were subject to explicit shorter waits from the start we uncover positive and statistically significant relationship for CABG and PCI patients in almost all years. For orthopaedic patients we find a positive and statistically significant association after 2004 when the 18-week referral to treatment (RTT) target was introduced. We find predominantly statistically insignificant results for the period prior. These findings raise safety and fairness concerns in the treatment of clinically complex and potentially urgent patients when the healthcare system is strapped with MWT targets.