Comments on: $600 million later, why have surgery waiting times gone up?

By: Doc

Doc — Tue, 30 Jun 2009 10:13:11 +0000

Sorry guys its really simple!
You treat the people that work in the system like crap and guess what you get?
A grossly ineffective, inefficient system!!
Lets take the example of the anaesthetists at hospital X who come to work at 7 am to attend an educational meeting. The bean counters cut the coffee provided to this meeting- not fresh percolated coffee but the International Roast brew (gag), because it costs too much. Lets then get ask these people to stay back late and finish elective lists- Doh!!
The cost of providing rubbish coffee to people is minimal, actually its 35 cents per person with a stale muffin thrown in, however that’s too much. When your value as a professional is so poor, the speed of the lists and the changeovers is glacial, no one cares if patients are cancelled, and the cost to you the tax payer is enormous.
Treat the doctors and nurses with some dignity. Clean up our work places. Give us a cheap cup of coffee and a glass of water. If you really knew the conditions we work under, for all the study and work we have put in you would be ashamed.
The private sector beckons? You bet, for 5 times more money, you get a clean workplace and a glass of water. People work harder when they are appreciated for the work they do.
The solution is in front of you.
Just ask the workers- it won’t cost you as much as you think!

By: Spectator

Spectator — Tue, 30 Jun 2009 06:52:07 +0000

As long as politicians, especially during elections, undertake to reduce or eliminate waiting lists for hospitals - they will fail, add another unnecessary rod to their backs & unrealistically raise everyone’s expectations. Waiting times for hospitals should carry a public health warning that ‘waiting is going to be inevitable’. Politicians should resist the temptation to promise things they cannot deliver. As Jennifer pointed out - clinical need is the important factor and every state and territory needs to have an effective and transparent unit that oversees clinical need. With an ageing population and improving treatments plus technology there is going to be an ever-increasing demand for beds leading to waiting times; we have to accept them and educate the community to expect them. Marginal reductions may well be achieved by charging for services in public hospitals but there is a cost for doing that. We still have by international standards a good, solid health system but every now and then it requires tuning. As far as the public hospital part of it is concerned this is one way to approach it.

By: Jennifer Doggett

Jennifer Doggett — Tue, 30 Jun 2009 05:26:06 +0000

Jim - I think the key issue is to look at who is on the waiting lists and who is being treated. If waiting times are longer but those people on waiting lists have less serious conditions (because people with higher levels of clinical need have been treated) then it is a positive outcome.

Scott - my reading of the evidence is that many forms of health care are price elastic. Although some forms of care (eg emergency) are relatively inelastic. Even if demand for hospital services overall were inelastic as you say, you need to take into account the availability of alternative options (such as private hospital or alternative forms of treatment). Overall demand may not change in response to price changes but it is likely to shift from one supplier to another.

By: Scott

Scott — Tue, 30 Jun 2009 04:50:00 +0000

There is a formula that is commonly used for calculating queue length and queue waiting times.
It basically involves an arrival rate (the rate at which customers arrive) and a service rate (the rate at which customers are served).
Now if queue waiting times have increased, it either means the arrival rate has increased (increased demand) or the service rate has decreased (more inefficiency) or a combination of the two.
The problem with your theory of increased demand based on lowered price is that it assumes Health care is a price elastic good/service. That demand will fluctuate widely based on price. In fact Health Care has been proven in numerouse studies to be, like petrol, more of an inelastic good. Demand doesn’t really change that much based on price changes.
The supermarket analogy isn’t a good example either. By adding an extra person to the checkout, you are effectively increasing the service rate. As customers move to the fast queue, all other queue waiting times will be reduced; not necessarily by 50% but there would be some reduction.
As to why waiting times in Public Hospital’s have not decreased with an $600 million increase, I can’t say but in my opinion, this theory is not the reason.

By: Jim Reiher

Jim Reiher — Tue, 30 Jun 2009 04:40:32 +0000

A great discussion with good insights, thanks Jennifer. So ….. what really is the answer, then, to long waiting times? I agree that it is silly to focus just on waiting times, to evaluate the effectiveness of the recent injection of new money. But … for those who are concerned about the waiting times, what is the answer?

I wonder if there comes a point where more and more resouces will eventually mean less waiting times? To use the shopping analogy: if more and more cashiers are put on some lines to speed up how fast they get customers through, then yes, more and more customers will jump onto those faster lines…. but eventually, when everyone is on that line…. and still more resources are poured into those same lines, then the times will reduce. Hmmm - does that mean we should slowly phase out the private hospitals altogether?

By: Marcus Dabner

Marcus Dabner — Tue, 30 Jun 2009 04:39:29 +0000

Good article. It highlights the critical factor that is often forgotten in health policy, which is that our system of health care involves choices and people will respond to incentives in fairly logical and understandable ways.

As am aside, I’ve worked in supermarkets and in (both public and private) hospitals and there is one difference between the two which I observed. The supermarket customers were prepared to pay what their groceries cost. The hospital customers are often not. Strange but true.