Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review
Open accessAbstract
As pressure increases on public health systems globally, a potential consequence is that this is transferred to patients in the form of longer waiting times to receive care. In this review, we overview what waiting for health care encompasses, its measurement, and the data available in terms of trends and comparability. We also discuss whether waiting time is equally distributed according to socioeconomic status. Finally, we discuss the policy implications and potential approaches to addressing the burden of waiting time. Waiting time for elective surgery and emergency department care is the best described type of waiting time, and it either increases or remains unchanged across multiple developed countries. There are many challenges in drawing direct comparisons internationally, as definitions for these types of waiting times vary. There are less data on waiting time from other settings, but existing data suggest waiting time presents a significant barrier to health care access for a range of health services. There is also evidence that waiting time is unequally distributed to those of lower socioeconomic status, although this may be improving in some countries. Further work to better clarify definitions, identify driving factors, and understand hidden waiting times and identify opportunities for reducing waiting time or better using waiting time could improve health outcomes of our health services.
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Interactive healthcare simulations can inform future healthcare robots and ease the global healthcare burden.
“Furthermore, these simulations could inform future healthcare robots (Yuan et al. 2023) and ease the global healthcare burden (McIntyre and Chow 2020), (i.e., 40% of the global population (WHO 2018).”
From Human-Clinical AI Agent Collaboration (2025) · cites this paper as McIntyre and Chow 2020
The Discussion and Policy Implications section describes waiting for care as a substantial burden that may grow globally and calls for innovation to reduce it. The Conclusions likewise propose innovations in care delivery, but the paper does not address interactive simulations or show that they could ease the broader global healthcare burden. The claim about robots is attached to a different citation. (LLM, conf=0.78)
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Sunkersing, D., Ramasawmy, M., Alwan, N. A., Clutterbuck, D., Mu, Y., Horstmanshof, K., Banerjee, A., & Heightman, M. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-080967 · Cited by 21 · see citing works
“The potential for these digital spaces to serve as outlets for shared experiences and coping strategies reflects a promising avenue for people living with Long COVID navigating the complexities of this condition, affirming the significance of such platforms within the broader landscape of…”
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“In particular, patients from medically underserved populations not only have a higher burden of disease but also experience longer wait times [1, 8, 9].”
BackgroundHigh-intensity theatre (HIT) lists to tackle the elective surgery backlog
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“As the pandemic progresses, long waiting lists are a problem across many countries with publicly funded health systems, such as Australia, New Zealand, Canada and Spain 4,5 .”
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“The session took 15.43 minutes on average to complete, below the waiting room time average of 20 to 40 minutes to avoid disrupting their clinical appointment [5].”
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Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia
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“Background With the rise in chronic disease prevalence and increasing demand for health care services worldwide, patients are experiencing excessive delays for specialist input [1].”
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“The waiting times also varied greatly from [21].”
MacNeill, A. L., MacNeill, L., Luke, A., & Doucet, S. A. (2024) · Journal of Medical Internet Research · doi:10.2196/49387 · Cited by 16 · see citing works
“…health issues that arise from the improper or incorrect use of a conversational agent: “If they [patients or clients] self-selected inappropriately to be seen by a virtual interface, and they delayed care and deteriorated … that would make my job a lot more complex” (Participant 13, physician).”
Curtis, K. A., Kennedy, B., Considine, J., Lam, M. K., Aggar, C., Shaban, R. Z., Hughes, J. A., Fry, M., Alkhouri, H., & Murphy, M. (2025) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2025.103948 · Cited by 12 · see citing works
AgentClinic: a multimodal benchmark for tool-using clinical AI agents
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“While these LLMs are not designed to replace medical practitioners, they could be bene fi cial for improving healthcare accessibility and scale for the over 40% of the global population facing limited healthcare access 5 and an increasingly strained global healthcare system 6 .”
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The Impact of Long Wait Times on Patient Health Outcomes: The Growing NHS Crisis
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The economic burden of idiopathic pulmonary fibrosis in Australia: a cost of illness study
Cox, I. A., de Graaff, B., Ahmed, H., Campbell, J. A., Otáhal, P., Corte, T. J., Moodley, Y. P., Goh, N. S. L., Hopkins, P. M.-A., Macansh, S., et al. (2022) · The European Journal of Health Economics · doi:10.1007/s10198-022-01538-7 · Cited by 11 · see citing works
“The number of specialists and waiting time to see a specialist varies by jurisdiction and waiting times can be longer in regional and remote areas when compared to major cities [53].”
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Smart Waiting Room: A Systematic Literature Review and a Proposal
Spoladore, D., Mondellini, M., Mahroo, A., Giglioli, I. A. C., Gaspari, S. D., Lernia, D. D., Riva, G., Bellini, E., Setola, N., & Sacco, M. (2024) · Electronics · doi:10.3390/electronics13020388 · Cited by 12 · see citing works
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“always used as an indicator of health service quality [72].”
BackgroundOdhiambo, A. J., Forman, L., Nelson, L. E., O'Campo, P. J., & Grace, D. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000714 · Cited by 9 · see citing works
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“Introduction Excessive wait times for specialist outpatient appointments are a significant problem facing health systems internationally and have increased substantially in the last decade [1].”
BackgroundExamining the Use of Autonomous Systems for Home Health Support Using a Smart Mirror
Dowthwaite, L., Reyes-Cruz, G., Pena, A. R., Pepper, C., Jäger, N., Barnard, P., Hughes, A., das Nair, R., Crepaz‐Keay, D., Cobb, S. V. G., et al. (2023) · Healthcare · doi:10.3390/healthcare11192608 · Cited by 9 · see citing works
Private health insurance in the United States and Sweden: A comparative review
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“21 The utility of comparing waiting times between countries that use different models of health care can be limited as the calculation and definition of wait times may differ considerably from nation to nation.”
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“Indeed, recent large-scale investigations have identified primary care waiting times as a “major policy concern across countries from the Organization for Economic Cooperation and Development” and a driver of socioeconomic inequity [16,17].”
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The Value of Vaccines in Maintaining Health System Capacity in England
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Self-citationArtificial intelligence medical scribes in allied health: a solution in search of evidence?
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Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5‐year experience
Jacob, J. G., Fernando, S. L., Nickolls, C., & Li, J. (2023) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.16398 · Cited by 6 · see citing works
Exploring Factors That Prolong the Diagnosis of Myasthenia Gravis
Nguyen, M., Clough, M., Cruse, B., van der Walt, A., Fielding, J., & White, O. B. (2024) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200244 · Cited by 6 · see citing works
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Exploring Healthcare Access Challenges Among South Asian Migrants in Australia: A Mixed‐Method Study
Nisar, M., Costa, N., Kolbe-Alexander, T. L., & Khan, A. (2025) · Health Promotion Journal of Australia · doi:10.1002/hpja.70008 · Cited by 6 · see citing works
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Dually‐enrolled patients choose providers with lower wait times: Budgetary implications for the VHA
Yee, C. A., Feyman, Y., & Pizer, S. D. (2022) · Health Services Research · doi:10.1111/1475-6773.13950 · Cited by 6 · see citing works
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Patients’ Expectations for App-Based Therapy in Knee Osteoarthritis: User-Centered Design Approach
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“…shortage of physi-otherapists (50 ‐ 70 per 100,000 inhabitants) leads to prolonged waiting times, a challenge also reported in Eastern and Southern Europe, as well as in the United Kingdom, Canada, and Australia, where delayed access to physiotherapy negatively impacts treatment outcomes [17,18].”
Pradhan, P., Sharman, A. R., Lacey, J., Dwyer, P., Hill, J., Davis, K. J., Craig, S. J., Wu, R. K., Ashford, B., Mitchell, J., et al. (2025) · Psycho-Oncology · doi:10.1002/pon.70056 · Cited by 5 · see citing works
“However, GPs in rural areas face significant challenges due to high patient turnover, resulting in longer waiting times and reduced reimbursement for consultation costs [23, 24].”
McIntyre, D., Chiang, J., Thiagalingam, A., Tong, A., & Chow, C. K. (2022) · BMJ Quality & Safety · doi:10.1136/bmjqs-2021-014664 · Cited by 5 · see citing works
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Economic Benefits of Reduced Waiting Times for Elective Surgeries: A Systematic Literature Review
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“As a consequence, healthcare systems face ongoing pressure to minimize waiting lists [6].”
Sociodemographic associations of geographic variation in paediatric tonsillectomy and adenoidectomy
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Assessment of Patient Waiting Time in Primary Health Care Settings in Rwanda: A Mixed-Method Study
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“[9,10] Furthermore, waiting time has the same negative effects in different contexts and settings.”
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Frailty Alerts Reduce Waiting Time and Length of Stay in the Emergency Department
Ehrlington, S. M., Wretborn, J., & Wilhelms, D. (2026) · Academic Emergency Medicine · doi:10.1111/acem.70239 · Cited by 4 · see citing works
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“As such, they represent instances when people’s needs for health are unmet, leading to exacerbated health issues stemming from delayed access to health and care services [1–7].”
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“15 16 – 20 However, most of the interventions described in the literature address specific referral barriers, not focusing on intervening at an organizational or system level.”
Marshall, D. A., Tagimacruz, T., Cepoiu‐Martin, M., Robert, J., Ring, B., Burston, M., Higgins, S., Hess, M., & White, J. S. (2022) · Journal of Medical Systems · doi:10.1007/s10916-022-01897-x · Cited by 4 · see citing works
“Mean number of gallbladder consults (2 years), 95% CI [LL, UL] 2,338 cons [1,501, 3,175] 314 cons [202, 427] 1,483 cons [952, 2,013] 216 cons [138, 293] 2,271 cons [1,458, 3,083] 296 cons [190, 402] 2,292 cons [1,472, 3,112] 303 cons [194, 411]”
Saouadogo, I., Massom, D. M., Kaboré, S. S., Djatsa, R. K. F., Seu, J., & Ngangue, P. (2024) · International Journal of Maternal and Child Health and AIDS · doi:10.25259/ijma_650 · Cited by 4 · see citing works
Effects of Community Assets on Major Health Conditions in England: A Data Analytic Approach
Moustakas, A., Thomson, L. J. M., Mughal, R., & Chatterjee, H. J. (2024) · Healthcare · doi:10.3390/healthcare12161608 · Cited by 4 · see citing works
“The community assets deployed here as explanatory variables of major health conditions may, for example, act as indirect covariates for socioeconomic status, not accounted for here.”
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Quality and Safety Indicators for Care Transitions by Older Adults: A Scoping Review
Fernando, R. L., Inacio, M. C. S., Sluggett, J. K., Ward, S. A., Beattie, E., Khadka, J., & Caughey, G. E. (2025) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.105424 · Cited by 5 · see citing works
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“We used the UK definition of an 18-week threshold to indicate delay in access to health care, but the definition of delay varies between countries [29, 31], so that caution should be taken when conducting international comparisons.”
Chen, C., Tsai, Y., Chou, C.-A., Weng, S.-J., Lee, W., Hsiao, L., Derek, N., & Ko, C.-P. (2022) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580221095797 · Cited by 4 · see citing works
“In the healthcare system, WT can be measured through different stages, including patients waiting for appointments, diagnoses, elective procedures, and time spent in waiting rooms.(21) In general, it refers to the period when a patient enters a clinic until he/she sees the doctor.”
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“The reason for this finding might be individuals who spent a longer waiting time for accessing health services may not attend their next visit to health services [33-35] because a longer waiting time reduces client satisfaction and subsequent service utilization [36,37].”
BackgroundPrimary Health Care: Our Experience From an Urban Primary Health Care Center in Greece
Galanakos, S. P., Bablekos, G. D., Tzavara, C. K., Karakousis, N. D., & Sigalos, E. (2023) · Cureus · doi:10.7759/cureus.35241 · Cited by 4 · see citing works
“Studies from different countries showed that the ED waiting time could be ranged from 20 to 74 minutes [12,13].”
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“Conversely, waiting time poses a major obstacle in accessing health care (McIntyre & Chow, 2020) and brings several other negative effects such as patient dissatisfaction (Lizaur-Utrilla et al., 2016; Nottingham et al., 2018), patient anxiety (Lizaur-Utrilla et al., 2016), and significantly poorer…”
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Sabatini, S., Hawes, F. M., Eluigwe, K. N., & Tang, E. Y. H. (2025) · Journal of Applied Gerontology · doi:10.1177/07334648241309734 · Cited by 3 · see citing works
“Second, management of behavioral symptoms was deemed challenging due to having to identify their underlying medical issues in residents with limited communication (Atee et al., 2021) and having to wait a long time before receiving advice from specialists (McIntyre & Chow, 2020).”
Re‐Evaluating Access in Healthcare: Focus on Quality of Care
Chen, A. M. (2025) · Public Health Challenges · doi:10.1002/puh2.70100 · Cited by 5 · see citing works
Memmel, E., & Kerschbaumer, L. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1810870 · Cited by 4 · see citing works
“Within this normative logic, access to healthcare at the system level is intended to be primarily determined by medical criteria rather than financial capacity (31–33).”
Kraus, M., Stacherl, B., Czypionka, T., & Mayer, S. (2024) · Public Health · doi:10.1016/j.puhe.2024.08.007 · Cited by 3 · see citing works
Interventions to reduce wait times in emergency departments in Canadian hospitals: A scoping review
Bhattacharyya, D. S., Neiterman, E., Mac, C., Cheung, K., Dang, E., Jaffer, A., McCready-Branch, B., Gauhar, A., & Butt, Z. A. (2025) · Public Health · doi:10.1016/j.puhe.2025.105778 · Cited by 4 · see citing works
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Zykienė, B., & Kalibatas, V. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08033-y · Cited by 3 · see citing works
Physician-to-Physician eConsultations to Ophthalmologists at an Academic Medical Center
Sherif, N. A., Lorch, A., & Armstrong, G. W. (2024) · Translational Vision Science & Technology · doi:10.1167/tvst.13.10.13 · Cited by 3 · see citing works
“26,27 In our study, the average response time to complete an eConsult was 1.6 days.”
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“24 Many people with severe joint disease wait months to years for surgery and over half experience a deterioration in health-related quality of life during this period.”
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“While a similar finding has been reported in other studies [36], our study population were university students hence time is essential in their lives as they must attend lectures and study.”
Early intervention for eating disorders: a call to action for inclusion of minoritized groups
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Pope, C. J., Driessen, A., Eccles, A., Wheeler, B., Bryce, C., Heath, J., Phillips, C., Gronlund, T. A., & Atherton, H. (2025) · Sociology of Health & Illness · doi:10.1111/1467-9566.70104 · Cited by 2 · see citing works
“A recent narrative review highlighted an average wait of 4 days to access primary care in Australia, the UK and Germany and reported a Canadian study that showed wait times of more than 2 weeks (McIntyre and Chow 2020).”
Depiction of conversational agents as health professionals: a scoping review
MacNeill, A. L., MacNeill, L., Yi, S., Goudreau, A., Luke, A., & Doucet, S. A. (2024) · JBI Evidence Synthesis · doi:10.11124/jbies-23-00029 · Cited by 2 · see citing works
Reengineering eADVICE for Long Waitlists: A Tale of Two Systems and Conditions
Richards, D., Caldwell, P. H. Y., Abdulrahman, A., Huben, A. V., Waters, K. A., & Scott, K. M. (2024) · Electronics · doi:10.3390/electronics13142785 · Cited by 2 · see citing works
- Authors
- McIntyre, D., & Chow, C. K.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- McIntyre, Daniel
- Venue
- INQUIRY: The Journal of Health Care Organization, Provision, and Financing
- Publisher
- SAGE Publications
- Published
- 2020-01
- Volume
- 57
- Pages
- 46958020910305-46958020910305
- ISSN
- 0046-9580 (ISSN-L)
- 1945-7243
- PMC
- PMC7235968
- OpenAlex
- W3021632058
- Cited by
- 219
- References
- 73
- Citations by year
- 2026: 32 · 2025: 66 · 2024: 48 · 2023: 32 · 2022: 29 · 2021: 11 · 2020: 1
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- INQUIRY The Journal of Health Care Organization Provision and Financing (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Health and Medical Research Council (APP1105447)
- National Heart Foundation of Australia (100808)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Keywords
- waiting time, health care access, healthcare system strain, elective surgery waiting lists, emergency department waiting times, socioeconomic inequalities in health care, international comparability, health policy
- MeSH terms
- Australia, Emergency Service, Hospital, England, Europe, Health Services Accessibility, Humans, Socioeconomic Factors, Waiting Lists, Global Health, Elective Surgical Procedures, Healthcare Disparities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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