The demand for private health insurance: do waiting lists or waiting times matter? CHERE Working Paper 2010/8

Besley, Hall, and Preston (1999) estimated a model of the demand for private health insurance in Britain as a function of regional waiting lists and found that increases in the number of people waiting for more than 12 months (the long-term waiting list) increased the probability of insurance purchase. In the absence of waiting time data, the length of regional long-term waiting lists was used to capture the price-quality trade-off of public treatment. We revisit Besley et al.?s analysis using Australian data and test the use of waiting lists as a proxy for waiting time in models of insurance demand. Unlike Besley et al., we find that the long-term waiting list is not a significant determinant of the demand for insurance. However we find that long waiting times do significantly increase insurance. This suggests that the relationship between waiting times and waiting lists is not as straightforward as is commonly assumed.waiting time, waiting lists, health insurance, regional aggregation

The Arizona KidsCare CHIP Enrollment Freeze: How Has It Impacted Enrollment and Families?

Outlines the implementation of Arizona's enrollment freeze on its Children's Health Insurance Program and its impact on the number of children on waiting lists, families facing losses in income and employer-sponsored coverage, and federal matching funds

Waiting lists and patient selection

We develop a model of waiting lists for public hospitals when physicians deliver both private and public treatment. Public treatment is free but rationed, i.e., only cases meeting some medical criteria area admitted for treatment. Private treatment has no waiting time but entails payment of a fee. Both physicians and patients take into account that each patient treated in the private practice schedule reduces the waiting list for public treatment. We show that physicians do not necessarily select the mildest cases from the waiting list. We provide sufficient conditions on the rationing policy under which cream skimming is always partial. We show that, to a large extent, one can bypass the analysis of doctors' behavior in the characterization of patient selection

USING A POINT SYSTEM IN THE MANAGEMENT OF WAITING LISTS: THE CASE OF CATARACTS

The objective of this study is to explore the possibility of applying a point system as a guide to the management of waiting lists in National Health Systems. Following recent contributions in the axiomatic theory of justice, the ethical properties of a point system are illustrated. In addition, we present the results of an experiment whose objective was to develop a point system for cataract extraction, based on social preferences. The results of the experiment have shown that the analytic methods used here, of focus groups, interview-administered questionnaires, conjoint analysis, and rank-ordered logit, can be usefully combined to determine the total priority score for each patient.Point System; Priority Criteria; Waiting Lists; Cataract.

The payment of hospital services: a waiting lists model

This paper analyses the incentive properties of prospective payment systems for hospital contracts, a key feature in many health systems’ reforms. Building on current literature, the model explicitly allows for the existence of waiting time, modelled as adversely affecting patients’ utility and therefore reducing social welfare. The model shows that rewarding hospitals for their demand leads to the first best solution, identified with respect to the relevant quality and quantity variables. The additional separate payment of a price per case is instead required when the social cost of waiting is introduced alongside the private costs. 1. Introduction. The last two decades have witnessed major changes in the organisation of health services. Various factors, among which the aging of the population and technical progress, led to growing demand levels and expectations; then to discontent, cost increases and general financial crisis. In general terms this scenario has characterised

Long term evaluation of operating theater planning policies

This paper addresses Operating Room (OR) planning policies in elective surgery. In particular, we investigate long-term policies for determining the Master Surgical Schedule (MSS) throughout the year, analyzing the tradeoff between organizational simplicity, favored by an MSS that does not change completely every week, and quality of the service offered to the patients, favored by an MSS that dynamically adapts to the current state of waiting lists, the latter objective being related to a lean approach to hospital management. Surgical cases are selected from the waiting lists according to several parameters, including surgery duration, waiting time and priority class of the operations. We apply the proposed models to the operating theater of a public, medium-size hospital in Empoli, Italy, using Integer Linear Programming formulations, and analyze the scalability of the approach on larger hospitals. The simulations point out that introducing a very limited degree of variability in MSS in terms of OR sessions assignment can largely pay off in terms of resource efficiency and due date performance