The VA scandal of long wait times is now well-known. Part of the reason why patients were left off official wait lists–ironically–was because VA senior staffers wanted to reduce wait times. Senior VA staff monitored wait times closely to check for any upticks. Some of the VA management at the Phoenix hospital believed the only way to hit their wait time target and save face with upper management was to keep a separate, off-the-books waiting list.
The VA, however, is not the only government organization that monitors wait times. In the UK, the National Health service also closely monitors wait times and sets wait time performance targets for all English hospitals. Like the VA in the US, hospitals in England are incentivized to reduce official waiting times for procedures such as elective surgery.
Using data from the Hospital Episode Statistics between 2006 and 2009, Marques et al. (2014) find that:
…although official waiting times decreased drastically in our study period, total waiting time in secondary care has not declined. Patients with shorter official waits spent a longer time in a ‘work-up’ period prior to inclusion in the official waiting list, and socio-economic inequities persisted in waiting times for joint replacement. We found no evidence that target policies achieved efficiency gains during our study period.
For the VA in the US and the NHS in England, wait time targets do not appear to be successful means of increasing access to care.