Long waiting times may impair patient health, decrease service satisfaction, and increase the use of private medicine.
The Ministry of Health decided to establish a national system for measuring and reporting public waiting times for physicians, as part of the national program for strengthening public medicine. Such a system is necessary to detect problems in the availability of services in medical specialties and gaps between geographical locations, and to plan actions to shorten long waiting times, according to the measurement results.
The program is led by the Medical Technologies, Information and Research Division led by Dr. Osnat Luxembourg and Dr. Racheli Wilf-Miron.
The expert team includes:
Gertner Institute for Epidemiology and Health Policy Research:
Information and Computing Unit - Ms. Arnona Ziv, Unit Manager; Ms. Irena Gimpelevitz;
Biostatistics and Biomathematics Unit - Dr. Amit Huppert, Unit Manager; Dr. Ilya Novikov.
Center for the Evaluation of Medical Technologies - Ms. Noga Boldor.
Ministry of Health:
Medical Technologies, Information and Research Division - Ms. Arava Kidder Tiroche, Ms. Sharona Vaknin, Dr. Inbar Zucker;
BI / GIS Department: Mr. Gennady Zaslavsky, Department Manager, Ms. Hani Levy, Mr. Zach Tagar.
Waiting time Theory & Statistics: Prof. Avishai Mandelbaum, Prof. Jacob Ritov, Prof. Yair Goldberg.
General, Maccabi, Leumi, Clalit
The first focus was development of a methodology for measuring waiting times for consultant medicine (specialist medicine) in the community. Representatives of the four HMOs, who each had experience in measuring its waiting times, consulted together. In the first phase, it was decided to focus on the five most utilized medical specialties - orthopedics, women, ENT, eyes and skin (about 70% of doctors' community counseling take place in these specialties). We examined in-depth measurement methods and information infrastructures available at the four health funds, as well as internationally accepted measurement methods. Based on the findings, it was decided to develop a methodology for measuring waiting times in a prospective approach.
Method of measurement
A unique method was developed for Israel to calculate waiting times, based on the available appointments that the four health funds offer to their policyholders according to geographical areas. More than 6000 physicians' diaries were included in all five specialties. To get the list of available appointments, doctors' diaries were sampled each day. The results shown reflect the samples taken during the period 12/18 - 02/19. The first 50 available appointments were collected from each physician's journal on each sampling day (31 consecutive days). About a million appointments served as a basis for calculating wait times. To estimate daily demand, the monthly activity volume for each physician's journal was used.
The method allows the calculation of waiting times offered by the funds in two ways: a) Waiting times for a specific doctor, i.e the method assumes the choice of a doctor (for example, an insured person wants to make an appointment for specific orthopedic doctor, Moshe Cohen) b) Waiting times for any physician, without choice of specific doctor (the insured person requests the closest appointment the fund has to offer for any orthopedist in the Judean Lowlands, for example). Inclusion and expense criteria defined in a dialogue with the health funds were defined.
How to display the wait times
Geographic Information System (GIS) is used to spatially display the results. The results are presented at three levels: at the national level, by 52 natural areas (where at least 3 doctors work) and by communities (where at least 7 doctors work).
Each specialty is represented by a separate map with a different leading color. The information displayed on the maps refers to the waiting times offered by the funds according to a particular doctor. This measure was chosen because it is generally the policyholder's preference, and because it is of medical importance to maintain the therapeutic continuum with that physician.
The leading metric selected, determining the color tones on the map is the median (50th percentile). The median reflects the number of days that half of appointment requesters wait less than, and half of queue applicants wait longer than. The system shows additional statistics such as average wait times, standard deviation, and additional percentages.
The interactive information system was opened for public use on the Ministry of Health's website on 16.04.2019.
Main Findings Using "Specific Doctor" Measurement Method
1. The median waiting time at the national level ranges from 6 days for an ophthalmologist appointment to 13 days for a dermatologist. In the most common specialty - orthopedics, the median is 11 days (Figure 1).
Figure 1: Waiting time (median, days) "specific physician", general Israel population, by specialization
2. The national average waiting time is, as expected, longer than the national median because it takes into account the long "tail" which includes appointments for seniors and specific specialists that patients are prepared to wait long to see. The average ranged from 12.7 days for women's medicine to 19.4 days for dermatology.
3. The indices show differences in waiting times between the natural areas and localities.
4. When the areas are grouped into six districts, the Northern District stands out favorably with short waiting times compared to the national median in four areas, and is identical to the national median in ophthalmology (see additional data). The Southern District is good compared to the national values in waiting time in dermatology, and less good in the other four areas.
5. Southern Negev Mountains is a natural area where waiting times cannot be calculated because of a minority of doctors in all five specialties. Keep in mind that the number of residents in this large natural area stands at only 441.
Additional Findings by Measurement Method by "Any Doctor"
When the insured wants the nearest line and is ready to contact "any physician," the waiting times will be considerably shorter (Figure 2). The shortest median for "any doctor" was demonstrated in women's and ophthalmology - 4 days, and the longest in dermatology - 8 days (additional data).
Figure 2: Waiting time (median, days) - The effect of choosing a doctor
After many years of using different approaches and measurement infrastructures, led by the Medical Technologies, Information and Research Division, we built the first national index to measure waiting times for community health consultants and the presentation of findings according to geographical areas.
The process was conducted in collaboration with the four health funds, which form part of the program.
The findings will form the basis for patient surveys and in-depth studies, with the aim of locating barriers and bottlenecks, in order to shorten waiting times in the required places.
Proving the feasibility and process applicability will allow the scope of measurement and the range of measurement approaches to be expanded.
Timely public reporting.
A dedicated survey in collaboration with Dr. Shuli Greenberg and Ms. Irit Elroy will examine in-depth the patient's experience in the context of waiting times, including the need, experience of booking an appointment, how appointments were made, how many appointments were kept, or waivered completely or in favor of private appointments.
Expanding the fields of measurement to less common medical subjects, such as cardiology and neurology.
Establishing Measurement of Waiting Times in Hospitals - In the first stage, waiting times for medical procedures (procedures) such as cardiac catheter surgery or hip replacement.