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When Time is Not on Your Side

Patient Experiences with Waiting for Home Care and Admission to a Nursing or Residential Home

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Abstract

Background: Waiting for care is common in many countries as a result of supply-side rationing. The effects that waiting has on patients and their environment have not received much attention thus far. We discuss the literature and present the results of a study on patient experiences with waiting for home care or admission to a nursing or residential home.

Methods: Late in 2003 we recruited people on a waiting list in the Waardenland and Midden-Holland regions in the Netherlands to participate in a survey. People were randomly selected from waiting lists for home care or admission to a nursing or residential home. A structured questionnaire was administered to either the patient or their proxy. Respondents answered questions about socioeconomic status, health, well-being, intermittent care use, care providers, and additional costs associated with waiting. Furthermore, the survey included questions addressing waiting (time) perceptions

Health status, well-being (or happiness), and different measures of the burden of waiting were assessed using a visual analog scale (VAS). Finally, respondents were asked to evaluate five statements regarding changes in health status and feelings of uncertainty, dependence, stress, and autonomy as a result of waiting for care, using a Likert-type scale (four categories ranging from ‘totally agree’ to ‘totally disagree’).

Data were analyzed using SPSS (version 12.0.1). Differences in means between people waiting for home care and admission were tested using one-way ANOVA; differences in proportions were tested using the Chi-squared test. Multivariate analysis was conducted to explore associations of the burden of waiting with background variables and characteristics of intermittent care received, using a forward conditional regression model.

Results: We found that waiting for care may have far-reaching consequences for patients and their families, and that approximately half of the patients waiting for care considered their current waiting time to be unacceptable. However, the mean burden of waiting is moderate and associated with the extent to which shortages in care are supplemented by support from informal caregivers, volunteers, or a domestic help.

Conclusions: Differences in how waiting time is perceived between individuals and care sectors are helpful building blocks for the development of more tailor-made policies aimed at reducing the burden of waiting time. These policies include additional support or quicker access to support at home for those most in need, and setting waiting time guarantees in order to reduce uncertainty.

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Notes

  1. A short anecdote illustrates this. When one of the authors (W. Brouwer) presented the Dutch waiting times for care to a group of British healthcare professionals who wished to learn more about the Dutch waiting times problem, one of the audience simply concluded, “You do not have a problem, you have the solution!”

  2. In the Netherlands, approximately 350 000 people receive home care and 200 000 people live in a residential or nursing home, of a total population of 16 million, of whom 1 million are aged ≥75 years.

  3. The disconfirmation paradigm poses that patient satisfaction with waiting is related to the size and direction of the difference between perceived and expected waiting times.

  4. Meiland et al.[60] studied the criteria used in patient selection from waiting lists for nursing home admission. They found that, in addition to urgency and chronology, efficiency and quality considerations and patient preferences for specific homes played a role, reflecting different notions of distributive justice.

  5. Research assistants were instructed to assess the ability of the respondent to participate in the interview. Interviews with respondents who provided unclear, inconsistent, or many “don’t know” answers were aborted or data discarded.

  6. Only a small minority of the respondents (4%) had a paid job. Results concerning productivity losses from waiting are therefore highly speculative. One in four had missed working days while on the waiting list and half indicated they were less productive at work (on average, they were 35% less productive).

  7. Maximum acceptable waiting times in the Netherlands are 6 weeks for home care and admission to a nursing home and 13 weeks for admission to a residential home.[69]

  8. Forward conditional regression model with Pin = 0.10 and Pout = 0.20; burden of waiting as dependent variable.

References

  1. Siciliani L, Hurst J. Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries. Health Policy 2005; 72(2): 201–15

    Article  PubMed  Google Scholar 

  2. Weale A. Rationing health care. BMJ 1998; 316(7129): 410

    Article  PubMed  CAS  Google Scholar 

  3. Schut FT, Van de Ven WP. Rationing and competition in the Dutch health-care system. Health Econ 2005; 14Suppl. 1: 59–74

    Article  Google Scholar 

  4. Hadorn DC and the Steering Committee of the Western Canada Waiting List Project. Setting priorities for waiting lists: defining our terms. CMAJ 2000; 163(7): 857–60

    Google Scholar 

  5. Smethurst DP, Williams HC. Power laws: are hospital waiting lists self-regulating? Nature 2001; 410(6829): 652–3

    Article  PubMed  CAS  Google Scholar 

  6. Maynard A. Rationing health care: an exploration. Health Policy 1999; 49(1–2): 5–11

    Article  PubMed  CAS  Google Scholar 

  7. Edwards RT. Points for pain: waiting list priority scoring systems. BMJ 1999; 318(7181): 412–4

    Article  PubMed  CAS  Google Scholar 

  8. Koopmanschap MA, Brouwer WBF, Hakkaart-van Roijen L, et al. The influence of waiting time on cost-effectiveness. Soc Sci Med 2005; 60: 2501–4

    Article  PubMed  CAS  Google Scholar 

  9. Brouwer WBF, Hermans HEGM. Private clinics for employees as a Dutch solution for waiting lists: economic and legal aspects. Health Policy 1999; 47(1): 1–17

    Article  PubMed  CAS  Google Scholar 

  10. Friele RD, Dane A, Andela M. Waiting is long: patients’ opinions about acceptable waiting times [in Dutch]. Medich Contact 2001; 56(14): 542–4

    Google Scholar 

  11. Bloom B, Fendrick A. Waiting for care, queuing and resource allocation. Med Care 1987; 25(2): 131–9

    Article  PubMed  CAS  Google Scholar 

  12. E C, Dahrouge S, Samant R, et al. Radical radiotherapy for cervix cancer: the effect of waiting time on outcome. Int J Radiat Oncol Biol Phys 2005; 61(4): 1071–7

    Article  PubMed  Google Scholar 

  13. Howard D. The impact of waiting time on liver transplant outcomes. Health Serv Res 2000; 35(5): 1117–34

    PubMed  CAS  Google Scholar 

  14. Koch KT, Piek JJ, David GK, et al. Does a waiting time for elective coronary angioplasty affect the primary success rate? Heart 1997; 77(5): 432–6

    PubMed  CAS  Google Scholar 

  15. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002; 74(10): 1377–81

    Article  PubMed  Google Scholar 

  16. Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int 2000; 58(3): 1311–7

    Article  PubMed  CAS  Google Scholar 

  17. Simpson CS, Fisher MA, Curtis MJ, et al. Correlation of waiting time with adverse events in patients admitted for nonelective permanent pacemaker implantation. Can J Cardiol 1998; 14(6): 817–21

    PubMed  CAS  Google Scholar 

  18. Brouwer WBF, Van Exel NJA, Van den Berg B, et al. Process utility from providing informal care: the benefit of caring. Health Policy 2005; 74(1): 85–99

    Article  PubMed  Google Scholar 

  19. Van Exel NJA, Koopmanschap MA, Van den Berg B, et al. Burden of informal care giving for stroke patients: identification of caregivers at risk of adverse health effects. Cerebrovasc Dis 2005; 19(1): 11–7

    Article  PubMed  Google Scholar 

  20. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 1999 Dec 15; 282(23): 2215–9

    Article  PubMed  CAS  Google Scholar 

  21. Brouwer WBF, van Exel NJA, Koopmanschap MA, et al. The valuation of informal care in economic appraisal: a consideration of individual choice and societal costs of time. Int J Technol Assess Health Care 1999; 15(1): 147–60

    Article  PubMed  CAS  Google Scholar 

  22. Koopmanschap MA, Van Exel NJA, Van den Bos GAM, et al. The desire for support and respite care; preferences of Dutch informal caregivers. Health Policy 2004; 68(3): 309–20

    Article  PubMed  CAS  Google Scholar 

  23. Van Exel NJA, Koopmanschap MA, Brouwer WBF. Costly discharge: shorter hospitalization causes difficulties for informal caregivers [in Dutch]. Med Contact 2003; 58(34): 1272–4

    Google Scholar 

  24. Brouwer WBF, Van Exel NJA, Koopmanschap MA, et al. Productivity losses before and after absence: as important as common? Health Policy 2002; 61(2): 173–87

    Article  PubMed  CAS  Google Scholar 

  25. Krol B, Groothoff JW, Van der Ploeg T, et al. The perceived waiting time: post-operation experiences of orthopaedic patients [in Dutch]. Tijdschrift voor Gezondheidswetenschappen 1999; 77: 84–9

    Google Scholar 

  26. Janssens LR, Kok LM, Hop JP. Waiting lists: an expensive remedy [in Dutch]. Amsterdam: SEO Economic Research, 2001

  27. Propper C. The disutility of time spent on the United Kingdom’s National Health Service waiting lists. J Hum Resour 1995; 30(4): 677–700

    Article  Google Scholar 

  28. Bishai DM, Lang HC. The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain. J Health Econ 2000; 19(2): 219–30

    Article  PubMed  CAS  Google Scholar 

  29. Brouwer WBF, Schut FT. Priority care for employees: a blessing in disguise? Health Econ 1999; 8(1): 65–73

    Article  PubMed  CAS  Google Scholar 

  30. Anderson G, Black C, Dunn E, et al. Willingness to pay to shorten waiting time for cataract surgery. Health Affairs 1997; 16(5): 181–90

    Article  PubMed  CAS  Google Scholar 

  31. Edwards RT, Boland A, Wilkinson C, et al. Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales. Health Policy 2003; 63(3): 229–37

    Article  PubMed  Google Scholar 

  32. Gauld R, Derrett S. Solving the surgical waiting list problem? New Zealand’s ‘booking system’. Int J Health Plann Manage 2000; 15(4): 259–72

    Article  PubMed  CAS  Google Scholar 

  33. Hanning M, Spångberg UW. Maximum waiting time: a threat to clinical freedom? Implementation of a policy to reduce waiting times. Health Policy 2000; 52(1): 15–32

    Article  PubMed  CAS  Google Scholar 

  34. Lack A, Edwards RT, Boland A. Weights for waits: lessons from Salisbury. J Health Serv Res Policy 2000; 5(2): 83–8

    PubMed  CAS  Google Scholar 

  35. Meiland FJM, Danse JAC, Wendte JF, et al. Urgency coding as a dynamic tool in management of waiting lists for psychogeriatric nursing home care in The Netherlands. Health Policy 2002; 60(2): 171–84

    Article  PubMed  CAS  Google Scholar 

  36. Stoop A, Brouwer WBF. The patient behind the figures [in Dutch]. Med Contact 2001; 56(44): 1610–2

    Google Scholar 

  37. Yeung RYT, Leung GM, McGhee SM, et al. Waiting time and doctor shopping in a mixed medical economy. Health Econ 2004; 13(11): 1137–44

    Article  PubMed  Google Scholar 

  38. Parkin D. Waiting lists for elective surgery: insights from time-to-event analysis on the impact of targets on waiting times. Proceedings of the 5th World Conference of the International Health Economics Association; 2005 Jul 10–13; Barcelona

  39. Varekamp I, Meiland FJ, Hoos AM, et al. The meaning of urgency in the allocation of scarce health care resources: a comparison between renal transplantation and psychogeriatric nursing home care. Health Policy 1998; 44(2): 135–48

    Article  PubMed  CAS  Google Scholar 

  40. Conner-Spady B, Estey A, Arnett G, et al. Steering Committee of the Western Canada Waiting List Project. Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty. J Health Serv Res Policy 2005; 10(2): 84–90

    Article  PubMed  Google Scholar 

  41. Alter DA, Basinski AS, Cohen EA. Fairness in the coronary angiography queue. CMAJ 1999; 161(7): 813–7

    PubMed  CAS  Google Scholar 

  42. Smethurst DP, Williams HC. Self-regulation in hospital waiting lists. J R Soc Med 2002; 95(6): 287–9

    Article  PubMed  CAS  Google Scholar 

  43. Dunn E, Black C, Alonso J, et al. Patients’ acceptance of waiting time for cataract surgery: what makes a wait too long? Soc Sci Med 1997; 44(11): 1603–10

    Article  PubMed  CAS  Google Scholar 

  44. Conner-Spady BL, Sanmugasunderam S, Courtright P, et al. Steering Committee of the Western Canada Waiting List Project. Determinants of patient satisfaction with cataract surgery and length of time on the waiting list. Br J Ophthalmol 2004; 88(10): 1305–9

    Article  PubMed  CAS  Google Scholar 

  45. Thompson DA, Yarnold PR. Relating patient satisfaction to waiting time perceptions and expectations: the disconfirmation paradigm. Acad Emerg Med 1995; 2(12): 1057–62

    Article  PubMed  CAS  Google Scholar 

  46. Thompson DA, Yarnold PR, Williams DR, et al. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med 1996; 28(6): 657–5

    Article  PubMed  CAS  Google Scholar 

  47. Besley T, Hall J, Preston I. The demand for private health insurance: do waiting lists matter? J Public Econ 1999; 72(2): 155–81

    Article  Google Scholar 

  48. Johannesson M, Johansson P-O, Söderqvist T. Time spent on waiting lists for medical care: an insurance approach. J Health Econ 1998; 17(5): 627–44

    Article  PubMed  CAS  Google Scholar 

  49. Jofre-Bonet M. Public health care and private insurance demand: the waiting time as a link. Health Care Manage Sci 2000; 3(1): 51–71

    Article  CAS  Google Scholar 

  50. Goddard JA, Tavakoli M. Referral rates and waiting lists: some empirical evidence. Health Econ 1998; 7(6): 545–9

    Article  PubMed  CAS  Google Scholar 

  51. Brouwer WBF, Van Exel NJA, Hermans HEGM, et al. Should I stay or should I go? Waiting lists and cross-border care. Health Policy 2003; 63(3): 289–98

    Article  PubMed  Google Scholar 

  52. Burge P, Devlin N, Appleby J, et al. Do patients always prefer quicker treatment? A discrete choice analysis of patients’ stated preferences in the London Patient Choice Project. Appl Health Econ Health Policy 2004; 3(4): 183–94

    Article  PubMed  Google Scholar 

  53. Howell GP, Richardson D, Forester A, et al. Long distance travel for routine elective surgery: questionnaire survey of patient’s attitudes. BMJ 1 9990; 200(6733): 1171–3

    Google Scholar 

  54. Ryan M, McIntosh E, Dean T, et al. Trade-offs between location and waiting times in the provision of health care: the case of elective surgery on the Isle of Wight. J Public Health Med 2000; 22(2): 202–10

    Article  PubMed  CAS  Google Scholar 

  55. Van Loon L, Horstman K, Houtepen R. Waiting anxiously: the meaning of waiting lists for patients [in Dutch]. Med Contact 2000; 55(44): 1554–6

    Google Scholar 

  56. Brouwer WBF, Stoop A. Knowing what to expect: booked appointments make waiting more bearable [in Dutch]. Med Contact 2001; 56(23): 908–9

    Google Scholar 

  57. Naumann S, Miles JA. Managing waiting patients’ perceptions: the role of process control. J Manag Med 2001; 15(4–5): 376–86

    Article  PubMed  CAS  Google Scholar 

  58. Stoop A, Vrangbaek K, Berg M. Theory and practice of waiting time data as a performance indicator in health care: a case study from the Netherlands. Health Policy 2005; 73(1): 41–51

    Article  PubMed  Google Scholar 

  59. Meiland F. Waiting list for nursing home admission gives limited insight of the problems: study in handling of the waiting list and the consequences for the patients [in Dutch]. Tijdschr Gerontol Geriatr 2002; 33(2): 53–5

    PubMed  Google Scholar 

  60. Meiland FJM, Danse JAC, Hoos AM, et al. The use of the waiting list in a fair selection of patients for nursing home care. Health Policy 1996; 38(1): 1–11

    Article  PubMed  CAS  Google Scholar 

  61. Meiland FJM, Danse JAC, Wendte JF, et al. Burden of delayed admission to psychogeriatric nursing homes on patients and their informal caregivers. Qual Health Care 2001; 10(4): 218–23

    Article  PubMed  CAS  Google Scholar 

  62. Caris-Verhallen WMCM, Kerkstra A. Continuity of care for patients on a waiting list for institutional long-term care. Health Soc Care Community 2001; 9(1): 1–9

    Article  PubMed  CAS  Google Scholar 

  63. Berthold H, Landahl S, Svanborg A. Intermittent care for old patients: when should it be offered? Compr Gerontol [B] 1988; 2(3): 135–40

    CAS  Google Scholar 

  64. Wiepkema A, Achterberg W, Tijmesen R. The project ‘wachtlijstservice’ (waiting list service) in the city of Utrecht: support, mediation and registration of psychogeriatric patients and their informal care givers during the waiting period [in Dutch]. Tijdschrift voor Verpleeghuisgeneeskunde 2004; 28(1): 11–3

    Google Scholar 

  65. Thompson L. Waiting time for nursing home admission in a voluntary single-entry system. Can J Aging 1997; 16(1): 17–29

    Article  Google Scholar 

  66. Zorgkantoor Friesland. Waiting lists in the care sector: a source of information and inspiration [in Dutch]. Leeuwarden: Zorgkantoor Friesland, 2004

    Google Scholar 

  67. College voor Zorgverzekeringen. Examination of available evidence on waiting lists for residential care [in Dutch]. Diemen: College voor Zorgverzekeringen, 2003

    Google Scholar 

  68. Van Exel NJA, Scholte op Reimer WJM, Brouwer WBF, et al. Instruments for assessing the burden of informal care giving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden. Clin Rehabil 2004; 18(2): 203–14

    Article  PubMed  Google Scholar 

  69. The National Public Health Compass [online]. Available from URL: http://www.rivm.nl/vtv/object_document/o2302n29636.html [Accessed 2007 Nov 2]

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Acknowledgements

The authors would like to thank the anonymous reviewer for the helpful comments and suggestions on a previous version of this manuscript. No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Department of Health Policy and Management (iBMG), Institute for Medical Technology Assessment (iMTA), Erasmus MC, Office WL4-125, PO Box 1738, 3000, DR Rotterdam, the Netherlands

    N. Job A. van Exel & Werner B. F. Brouwer

  2. Trias Health Insurance, Gorinchem, the Netherlands

    Marion de Ruiter

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  1. N. Job A. van Exel
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  2. Marion de Ruiter
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  3. Werner B. F. Brouwer
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Correspondence to N. Job A. van Exel.

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van Exel, N.J.A., de Ruiter, M. & Brouwer, W.B.F. When Time is Not on Your Side. Patient-Patient-Centered-Outcome-Res 1, 55–71 (2008). https://doi.org/10.2165/01312067-200801010-00008

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