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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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“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
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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
“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
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
“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.”
BackgroundWang, H., Sambamoorthi, N., Robinson, R. D., Knowles, H. C., Kirby, J. J., Ho, A. F., Takami, T., & Sambamoorthi, U. (2024) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.13293 · Cited by 4
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 7
Fairley, C. K., Ong, J. J., Zhang, L., Varma, R., Owen, L., Russell, D. B., Martin, S., Cotter, J., Thng, C., Ryder, N., et al. (2025) · Sexual Health · doi:10.1071/sh25026 · Cited by 4
Fluck, D. S., Jackson, E., Llamas-Montoya, A., Chana, A. S., Kelly, K., JONES, G. L., Rees, J., Tudose, J., Jones, Y., Finch, J. S., et al. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02515-5 · Cited by 5
“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
“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.”
BackgroundMeskele, B., Kerbo, A. A., Baza, D., & Markos, M. (2023) · Pan African Medical Journal · doi:10.11604/pamj.2023.44.62.34493 · Cited by 4
“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
“Studies from different countries showed that the ED waiting time could be ranged from 20 to 74 minutes [12,13].”
BackgroundRukiko, M. D., Mwakalobo, A. B. S., & Mmasa, J. J. (2023) · Cogent Business & Management · doi:10.1080/23311975.2023.2198075 · Cited by 7
Kreiseder, F., & Mosenhauer, M. (2022) · European Journal of Management Issues · doi:10.15421/192201 · Cited by 4
“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…”
BackgroundLev, N., Leeman, H. M., Gonen, O., & Davidovitch, N. (2024) · Preprints.org · doi:10.20944/preprints202406.0066.v1 · Cited by 4
Sabatini, S., Hawes, F. M., Eluigwe, K. N., & Tang, E. Y. H. (2025) · Journal of Applied Gerontology · doi:10.1177/07334648241309734 · Cited by 3
“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
Memmel, E., & Kerschbaumer, L. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1810870 · Cited by 4
“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
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 7
Chan, R. K., Dinh, D. T., Hare, D. L., Lockwood, S. M., Neil, C., Prior, D., Brennan, A., Lefkovits, J., Carruthers, H., Reid, C. M., et al. (2021) · Heart Lung and Circulation · doi:10.1016/j.hlc.2021.08.020 · Cited by 3
Zykienė, B., & Kalibatas, V. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08033-y · Cited by 3
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
“26,27 In our study, the average response time to complete an eConsult was 1.6 days.”
BackgroundInfluentialAwan, A., Browne, J. L., Ibrahim, A., Butler, C., & Drovandi, A. D. (2025) · BMJ · doi:10.1136/bmj-2024-080992 · Cited by 3
Chavarría, A. R., & Calderón, A. (2022) · Población y Salud en Mesoamérica · doi:10.15517/psm.v20i1.48983 · Cited by 2
Bills, E. R., Dimopoulos, A., Burke, A. L. J., Collins, K., Linedale, E., Hume, V., Yeoh, J., Coles, S., Nolan, M., Southam, K., et al. (2024) · Journal of orthopaedic surgery · doi:10.1177/10225536241234032 · Cited by 2
“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.”
Shamu, P., Christofides, N. J., & Mullick, S. (2025) · PLoS ONE · doi:10.1371/journal.pone.0333270 · Cited by 2
“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
Egbert, A. H., & Schram, S. J. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2564947 · Cited by 3
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
“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
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
Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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
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