By NextBestFitLegal wait-time guarantees
If care isn't provided within a set time, patients may go to another provider, even abroad, at the payer's cost.
Legal maximum waits with care elsewhere when missed.
Review ledgerHow this path connects
This path
Legal wait-time guarantees
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Set legal maximum waits by service
- Let patients go elsewhere at payer cost when exceeded
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Longer waits if demand grows faster than capacity
A time limit gives patients a concrete right to timely care by allowing them to use another provider, including abroad, at the payer’s cost.
What it creates or worsens
- Depends on other changes to work
Allowing patients to switch providers after a care deadline requires spare capacity somewhere else.
- Targets and quality metrics invite gaming
A care deadline can encourage gaming of referral dates.
Who's affected
Who gains
- People with employer coverage
- Longer waits if demand grows faster than capacity: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs
- Longer waits if demand grows faster than capacity: They need specialists and procedures most often.
- Hospitals, clinics, and care organizations
- Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.
Who loses
- Hospitals, clinics, and care organizations
- Depends on other changes to work: Allowing patients to switch providers after a care deadline requires spare capacity somewhere else.
- People with ongoing or specialist care needs
- Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.
Where it has been tried
- Denmark, Sweden: Treatment guarantees with free choice of another hospital.
- Denmark: Danish regions made a historically high 242,060 referrals to private hospitals and clinics in 2023, as reported by Danske Regioner in January 2024.Sources: Danske Regioner (2024)