Why Long Wait Times for Health Care Should Matter – and How to Reduce Them

Long waiting times for public health care services are common in Latin America, as confirmed by the available data. For instance, in 2022 the median waiting time for hip replacements – a common elective surgery – was 408 days in Chile and 632 in Costa Rica. And even for coronary bypass surgery, more than three in four patients have been on a waiting list for more than three months. 

What are the effects of long wait times? And what are the strategies to reduce them? As recent work supported by the Inter-American Development Bank (IDB) shows, there is ample scope for doing so. Read through to find out how!

The Unwanted Effects of Long Wait Times

In healthcare, waiting times and waiting lists are not just minor inconveniences; they significantly affect health outcomes, equity, quality of care, and the efficiency of health systems, as well as citizen trust and confidence. Let’s review some of the undesirable effects produced by prolonged waits for health care.

• Health outcomes at risk. Waiting lists are bad for people’s health. They represent delays in providing essential care to patients and can lead to worsened health conditions and prolonged suffering. While being on waiting lists, patients have to live with their health problems, risking complications and deteriorating quality of life.
  
• Equity concerns. The presence of waiting lists often highlights a lack of prioritization within healthcare systems. Although patients with urgent needs should ideally receive care first, this is not always the case. In addition, some patients, particularly those who can afford it, may bypass waiting lists by seeking care in the private sector. In some countries, patients can use the legal system to get faster access to care, effectively skipping the line and thereby increasing the wait time for others.
  
• Poor quality and patient-centered care. Good quality of care means focusing on the patients and their particular needs, and to empower them to become active participants in their care. Long waiting lists are the opposite of such patient-centered care, as they often disregard individual needs and fail to empower them. Furthermore, extended wait times can erode confidence and trust in the healthcare system, as patients worry whether they will receive the services they need in time and citizens wonder how much they can rely on the healthcare system in times of need.
  
• Low efficiency. Long waiting lists are inefficient as they lead to worse health outcomes, poor quality and a suboptimal use of resources. Moreover, waiting lists are also indicators of gaps in health system capacity and performance.

Strategies to Reduce Long Waiting Times

Addressing waiting times requires tackling their root causes: the imbalance between demand for and supply of healthcare services, and inefficient processes.

• Increase supply: This includes making more appointment slots available or rethinking resource use through task shifting, e.g., shifting responsibilities from scarce doctors to more available nurses. Some public health systems also have introduced maximum waiting times (though they are often not met) and some will pay for patients to use the private sector if wait times are too long. These strategies, however, can be protracted and costly.
  
• Reduce demand: Effective measures include prevention through better primary healthcare, which helps avoid diseases from developing or getting worse. Another approach is to improve the allocation of patients and cleaning of waiting lists through prioritization and triage. Actively monitoring and working with patients on waiting lists is also a way to engage them in their care. All this can alleviate pressure on the healthcare system.
  
• Optimize processes: Better management and process innovations can reduce waiting times, lower uncertainty and improve patient experiences. For example, the City of Buenos Aires uses a chatbot for its appointment management process, including reminders and management of cancellations and rescheduling. This is expected to reduce missed appointments and thereby help maximize existing capacities. Optimization is not just about technical processes but can include engaging more closely with patients.

No Need to Wait: Strategies Put into Practice

A recent project, supported by the IDB, focused on waiting times for three medical specialties in the Chilean public health system. The project investigated the current flow of patients and identified opportunities to enhance process and personnel management to reduce the risk of prolonged waiting times. Subsequently, the project piloted redesigned processes related to clinical management and structural processes to improve the patient journey. The results of the pilot are promising and include:

• A general decrease in waiting times;
• A greater number of resolved cases that had the longest wait;
• A greater number of closed cases and discharges due to medical reasons and effective contact with patients.

This was achieved through measures that are key to more efficient management:

• Adopting a patient management protocol for each specialty;
• Leveraging existing human resource capabilities;
• Implementing a dynamic prioritization model reclassifying clinical risk level;
• Introducing new criteria for assigning hours and scheduling;
• Improving the timing of examinations to enhance the resolution of the first consultation;
• Incorporating telemedicine for low-complexity consultations to strengthen the resolution of the primary level with the guidance of a specialist.

This project shows the potential to substantially shorten waiting lists and demonstrates that this does not need to be complicated or expensive. It does, however, require careful attention in the design and implementation, and a strong focus on patients and their needs.

Next in Line!

Waiting times are more than just numbers: They reflect the health system’s capacity to serve its population effectively and equitably. By understanding and addressing the complex issues surrounding waiting times and waiting lists, we can make strides toward a healthcare system that prioritizes health outcomes, equity, quality and efficiency, and that instills confidence and trust. It doesn’t need to be complicated or costly. There’s no reason to wait!

To find out more about the lessons learned throughout the pilot and the experts’ view of this experience, we invite you to review our recent webinar on this study. Leave your comment if you have more experiences to add! We value your insights and contributions.