Cited by 220Healthcare Systems and PracticesEmergency and Acute Care StudiesHealth Services Management and Policy

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Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review

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McIntyre, Daniel, Chow, Clara K.·2020·INQUIRY: The Journal of Health Care Organization, Provision, and Financing

DOI 10.1177/0046958020910305PMC PMC7235968

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Abstract

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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Figure 1. Schematic of the time patients spend waiting for care with examples from the United States, Australia, and the United Kingdom.1,3,6,8-10,32,33CC BY-NC · PubMed Central

Figure 2. Measurement of ED waiting times: Australia vs the United Kingdom.10,67 Note. UK: Total ED time refers to the time from arrival to discharge, transfer, or admission to hospital. Australia: ED wait times refer to the time from triage to first clinical contact. Being seen “on time” refers to first contact occurring within the clinically recommended time for each triage category: resuscitation (within seconds), emergency (within 10 min), urgent (within 30 min), semi-urgent (within 60 min) and nonurgent (within 120 min). ED = emergency department.CC BY-NC · PubMed Central

Figure 3. Measurement of elective surgery waiting times: Australia vs the United Kingdom.1,29 Note. In UK, RTT time for elective surgery refers to the time from GP referral for consultant-led treatment to the initiation of this treatment. In Australia, elective surgery waiting time refers to the time from addition to removal from surgery waiting lists and does not include the time from GP referral. RTT = referral to treatment; GP = general practitioner.CC BY-NC · PubMed Central

Figure 4. Waiting-time trends in emergency departments and for elective surgery in Australia and NHS England, 2008/2009-2017/2018.1,6,9,10,22,26,83,84CC BY-NC · PubMed Central

Figure 5. Elective surgery waiting time between 11 countries. Data from the Commonwealth Fund’s 2016 survey.25CC BY-NC · PubMed Central

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Authors: McIntyre, D., & Chow, C. K.
Affiliations: The University of Sydney (AU)
Corresponding author: McIntyre, Daniel
ORCID: McIntyre, Daniel
Chow, Clara K.
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
DOI: 10.1177/0046958020910305
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: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified)
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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Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review

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