By NextBestFitWaiting-time guarantees as a backstop
Budgets are fixed, but if a hospital exceeds a maximum wait, the patient can be treated elsewhere and the cost is charged to the original hospital's budget.
Wait guarantees as a backstop.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Charge late hospitals for care elsewhere
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Fixed budgets can ration care
Allowing patients to receive treatment elsewhere after a hospital exceeds the maximum wait protects patients while keeping fixed budgets, with the original hospital paying the cost.
- Longer waits if demand grows faster than capacity
A maximum-wait rule allows delayed patients to receive treatment elsewhere at the original hospital’s expense.
- Depends on other changes to work
Allowing delayed patients to move to another hospital requires spare capacity elsewhere.
- Adds paperwork, coordination, or complexity
Charging treatment at another hospital back to the original hospital’s budget requires complex accounting.
Who's affected
- People with ongoing or specialist care needs
- Fixed budgets can ration care: Hospitals may slow elective procedures when demand exceeds fixed budgets.
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- Taxpayers and public budgets
- Fixed budgets can ration care: Global budgets cap spending.
- Hospitals, clinics, and care organizations
- Depends on other changes to work: Allowing delayed patients to move to another hospital requires spare capacity elsewhere.
Where it has been tried
- Denmark: In Denmark, coupling a maximum waiting-time guarantee with extended free hospital choice reduced experienced waiting times for elective surgery from about 12 weeks in 2001 to 7.6 weeks in 2011 (2013).Sources: OECD Health Policy Studies (2013)