Edited by Alistair McGuire and Joan Costa-Font
Chapter 6: A Million Years of Waiting: Competing Accounts and Comparative Experiences of Hospital Waiting Time Policy
6 A million years of waiting: competing accounts and comparative experiences of hospital waiting-time policy Alec Morton and R. Gwyn Bevan 1. INTRODUCTION Waiting time for hospital care is one of the most easily measured dimensions of performance of a health care system, and one of the few dimensions that patients can assess unambiguously. Perhaps for that reason, it has been one of the most contentious and politically sensitive issues in health policy in many countries (although, arguably, patients should be more worried about variations in access and outcomes). The capacity for hospital waiting times to create acute political embarrassment can be seen in the headlines from various UK national newspapers during the period 2001–02 when popular concern about waiting times was running high (see Box 6.1). As a result of the high degree of exposure of this issue, waiting times have become an issue on which everyone has an opinion. At the roughest, rawest level, it is possible to distinguish two stances in lay and policy discussions about waiting times: ● ● policy action to improve waiting times is impossible, impractical, expensive and ineffectual, and has adverse effects on other hard-to-measure dimensions of quality of care; policy action to improve waiting times is possible, practical, desirable, and may even save money. We call the former stance the ‘miserabilist stance’ and the latter stance the ‘meliorist stance’. Yet understanding the consequences of policy action requires getting beyond these stances, and understanding how and why health care systems generate waits. A central...
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