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Some Economics of Hospital Waiting Lists in the NHS

ABSTRACT The article concerns waiting for inpatient admission in the NHS and focuses on three aspects of this persistent problem. These are the merits or otherwise of rationing health care through waiting as opposed to pricing, the interpretation of waiting lists as a proxy for excess demand in the ‘market’ for inpatient care, including a critical examination of the logic and empirical evidence underlying the view that inpatients pay a time price for their admission, and the question of an admissions index to replace the largely inconsistent admission criteria currently employed in the hospital service. In particular the construction of an index incorporating the values of fairness and efficiency is discussed and the following characteristics suggested for inclusion: time already spent on the waiting list; urgency based on expected rate of deterioration of the patient's condition; urgency based on the patient's health status; urgency based on the ‘social productivity’ of the patient and the number of economic dependants; and urgency based on other social factors. The conclusions are that emphasis should be placed on waiting times rather than lists, that systematic admissions criteria should be developed and that the latter should incorporate social judgements which to date have been ignored or dominated by clinical judgements.