Cure Alveolar Soft Part Sarcoma International (iCureASPS)

Abstract
Long waiting times for health care is an important health policy issue in many countries, and many have introduced some form of national waiting time guarantees. International comparison of waiting times are critical for countries to improve policy and for patients to be able to make informed choices, especially in Europe, where patients have the right to seek care in other countries if there is undue delay.

The objective of this study was to describe how countries measure waiting times and to assess whether waiting times can be compared internationally. Twenty-three OECD countries were included. Information was collected through scientific articles, official and unofficial documents and web pages. Fifteen of the 23 countries monitor and publish national waiting time statistics and have some form of waiting time guarantees. There are significant differences in how waiting times are measured: whether they measure the “ongoing” or “completed” waiting period what kind of care the patient is waiting for; the parameters used; and where in the patient journey the measurement begins. Current national waiting time statistics are of limited use for comparing health care availability among the various countries due to the differences in measurements and data collection. Different methodological issues must be taken into account when making such cross-country comparisons.

Within the given context of national sovereignty of health systems it would be desirable if countries could collaborate in order to facilitate international comparisons. Such comparisons would be of benefit to all involved in the process of continuous improvement of health services. They would also benefit patients who seek cross-border alternatives for their care.

1. Introduction
Waiting times have been linked to inefficiencies in health care delivery, prolonged patient suffering and dissatisfaction among the public [1], [2], [3], [4], they have become important policy issues in many OECD countries, where national waiting time statistics are routinely collected in various countries [5], [6], [7]. Some studies have compared waiting times between countries. Most of them collected data by means of surveys of the general public [8], [9], [10], [11], [12], [13], [14], [15], [16], hospitals [17], patient organisations [18], researchers [19] or questionnaires sent to administrative bodies [18], [20], [21]. No study has relied on routinely collected national waiting time statistics.

Waiting times arise as the result of the demand and supply imbalance. If demand exceeds supply, a queue forms [22], [23]. Additionally the waiting time situation can also be difficult to improve long-term if the variation in supply does not adapt to variation in demand. Excess demand during a certain period of time generates queues, whereas temporary excess capacity cannot be saved up for future use [24]. Differences in waiting time for the same procedure can depend on differences in indication or clinical threshold for when the procedure is performed [25]. Thus, the fact that one care giver has a shorter queue for cataract surgery than another can be due to the fact that its waiting list threshold is higher. The speed at which patients are taken off the waiting list is affected by the frequency with which surgery is performed [26]. A newly published OECD report suggest a negative association between waiting times and the availability of curative care beds, and to a lesser extent, between waiting times and public health care spending per capita. However, supply is not solely the explanation to waiting times. There are some countries with high spending, beds or doctors that still have waiting times [27].

In a literature search of published articles and reports, we found limited documentation comparative studies of waiting times from regular reporting systems and routine efforts to reduce waiting times. Also, information of interest to the patients could not be found easily. International comparisons of waiting times are important for patients in Europe when making informed choices about cross-border care [19], [28].

The objective of this study was to describe how countries measure waiting times and to assess whether waiting times can be compared internationally.