Who waits for surgeries in Portugal?

Wait lists and wait times for scheduled surgery are common in National Health Services-type systems. The analysis of factors that impact wait times for access to surgery has been consistently focused on patients who underwent surgery, ignoring patients that had been on the wait list but did not benefit from surgery due to cancellation by the hospital. This paper studies the effect that cancellation episodes have on understanding wait times.

The paper analyzes access to scheduled surgery in the Portuguese National Health Service, using all available data between 2011 and 2015. The dataset combines patients submitted to surgical procedures and patients scheduled for surgery but who did not have the surgery due to cancellation.

The paper shows that estimations including only patients submitted to surgery present a biased picture of the factors affecting wait times. The research identifies two noteworthy biases, which suggest corresponding public policy actions. First, the gender bias identified in the literature (men have shorter wait times) is much lower than estimated by models without cancellations, implying that policymakers might employ more resources than necessary in policies directed at eliminating discrimination against women. Second, there is a significant age bias (older patients have to wait longer) that was not identified by the model without cancellations, implying that policymakers might neglect an important lack of equity in access to scheduled surgeries.

The inclusion of cancellation episodes is crucial especially in health systems where cancellation rates are high or in contexts such as the COVID-19 pandemic, in which countless surgeries were cancelled or postponed worldwide.

Click here to go to the paper by Joana Cima and Álvaro Almeida.