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34. Insights into how universal, tax-funded, single payer health systems manage their waiting lists: A review of the literature.

Author

Amigoni, Francesco, Lega, Federico, and Maggioni, Elena

Subjects
POLICY sciences, OUTPATIENT services in hospitals, SINGLE-payer health care, HEALTH insurance, OUTPATIENT medical care, TAXATION, SYSTEMATIC reviews, MEDLINE, LITERATURE reviews, ONLINE information services
Abstract

Background: A conspicuous consequence of gatekeeping arrangements in universal, tax-funded, single-payer health care systems is the long waiting times. Besides limiting equal access to care, long waiting times can have a negative impact on health outcomes. Long waiting times can create obstacles in a patient's care pathway. Organization for Economic Co-operation and Development (OECD) countries have implemented various strategies to tackle this issue, but there is little evidence for which approach is the most effective. This literature review examined waiting times for ambulatory care. Objective: The aim was to identify the main policies or combinations of policies universal, tax-funded, and single-payer healthcare systems have implemented to improve the governance of outpatient waiting times. Methods: Starting from 1040 potentially eligible articles, a total of 41 studies were identified via a 2-step selection process. Findings: Despite the relevance of the issue, the literature is limited. A set of 15 policies for the governance of ambulatory waiting time was identified and categorized by the type of intervention: generation of supply capacity, control of demand, and mixed interventions. Even if a primary intervention was always identifiable, rarely a policy was implemented solo. The most frequent primary strategies were: guidelines implementation and/or clinical pathways, including triage, guidelines for referral and maxim waiting times (14 studies), task shifting (9 studies), and telemedicine (6 studies). Most studies were observational, with no data on costs of intervention and impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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47. List of Contributors

Author

Al Ahdab, Ola Ghaleb, primary, Ali, Alshabi, additional, Almarsdóttir, Anna Birna, additional, Annemans, Lieven, additional, Ashoush, Nermeen, additional, Baker, Danial E., additional, Blondal, Anna Bryndis, additional, Brennan, Emily, additional, Brown, Lawrence, additional, Buffington, Daniel, additional, Calabrese, Sam, additional, Chaiyakunapruk, Nathorn, additional, Chilkoti, Deepak C., additional, Choon, Wai Yee, additional, Cooper, Jason C., additional, Costa de Sousa, Ivellise, additional, Dankó, Dávid, additional, Davis, Amanda, additional, Decerbo, Mark, additional, Decker, Brian S., additional, Dilokthornsakul, Piyameth, additional, Efendie, Benny, additional, Feturi, Firuz Gamal, additional, Gajraj, Elangovan, additional, Gharat, Manjiri, additional, Granas, Anne Gerd, additional, Herman, Ronald A., additional, Hiligsmann, Mickael, additional, Hill, Angela, additional, Hill, Lilian H., additional, Hoefer, Carrie, additional, John, Denny, additional, Jones, Emily P., additional, Joseph, Siby, additional, Joshi, Sachita, additional, Junaid, Toluwalope, additional, Khakurel, Balkrishna, additional, Khalifa, Sherief, additional, Kisor, David F., additional, Klika, Christoph, additional, Kruger, Johann, additional, Kumar, Kiran, additional, Lee, Shaun Wen Huey, additional, Lega, Federico, additional, Leong, Christine, additional, Li, Hong, additional, Lockman, Kashelle, additional, Suresh Madhavan, S., additional, Maine, Lucinda L., additional, Marriott, Jennifer, additional, Miah, Mohammad Kowser, additional, Naeem, Saba, additional, New, James P., additional, Osipenko, Leeza, additional, Paulino, Ema, additional, Picone, Mary Frances, additional, Pilch, Nicole A., additional, Rajendran, Nisha, additional, Raut, Asawari, additional, Ray, Mary E., additional, Roberts, Jason A., additional, Rouse, Michael J., additional, Sambandan, Gunasakaran, additional, Scheckelhoff, Douglas, additional, Shaik, Imam Hussain, additional, Shrestha, Rishav, additional, Sokn, Erick, additional, Steinke, Douglas T., additional, Tarn, Yen-Huei (Tony), additional, Thanukrishnan, Harisudhan, additional, Thomas, Dixon, additional, Tian, Shuhui, additional, Tsui, Vincent W.L., additional, Turcu-Stiolica, Adina, additional, Vadlamudi, Rao, additional, Vaida, Allen J., additional, Vaidya, Raj, additional, Van Cuyk, Matthew P., additional, Venkataramanan, Raman, additional, Vlasses, Peter H., additional, Vos, Susan S., additional, Weeda, Erin R., additional, Wisniewski, Christopher S., additional, Woods, David J., additional, Wu, Xuemei, additional, Zachariah, Seeba, additional, and Zarembski, Dawn G., additional

Published
2019
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48. Patient Flow Logistics

Author

Lega Federico, Pellegrino, Rossella, Villa, Stefano, pellegrino rossella (ORCID:0009-0002-9277-4937), stefano villa (ORCID:0000-0001-8111-3098), Lega Federico, Pellegrino, Rossella, Villa, Stefano, pellegrino rossella (ORCID:0009-0002-9277-4937), and stefano villa (ORCID:0000-0001-8111-3098)

Abstract

Patient flow logistics has to do with the management of patient physical paths/routes within a healthcare delivery organization from the very first access, to the triage towards the most appropriate setting, until the very end phase of discharge and integration with post-acute care. The focus is the optimization of patient flows throughout all the different production units along the entire healthcare chain.

Published
2023

49. From volume to value: Improving peri-operative elective pathways through a roadmap from fast-track orthopedic surgery.

Author

Pennestrì, Federico, Lega, Federico, and Banfi, Giuseppe

Subjects
PERIOPERATIVE care, ELECTIVE surgery, LENGTH of stay in hospitals, MEDICAL care, MEDICAL care costs, PATIENT-centered care, ARTIFICIAL joints, CONTINUUM of care, QUALITY assurance, INTERPROFESSIONAL relations, HEALTH care teams, BUDGET, COMMITMENT (Psychology), POLICY sciences, GOAL (Psychology)
Abstract

Healthcare institutions face the pressure generated by modern medicine and society, in terms of increasing expectations and financial constraints. Chronic patients need multidisciplinary care pathways to preserve their wellbeing across the entire journey. The orthopaedic community has been particularly receptive in testing solutions to align good clinical outcomes and financial sustainability, given the increase in elective procedures provided among aging populations to alleviate pain and reduce disability. Fast-track (FT) total joint arthroplasty (TJA) and bundled payments (BPs) offer relevant examples both from the clinical and the financial perspective; however, they have not been evaluated in combination yet. The aim of this manuscript is to provide a road map to improve the value of high-volume, multidisciplinary elective procedures, with potential applications in a vast number of surgical specialties, (1) based on an integrated financial budget per episode of care (the BP), (2) building on lessons from a review of the literature on FT TJA. Although clinical outcomes vary from procedure to procedure, the coordination between the single treatments and providers involved across the patient journey; the commitment of patients and relatives; and the systematic adoption of patient-reported outcomes; can add further value for the benefit of patients, healthcare funders and providers, once essential clinical, financial and administrative conditions are guaranteed. [ABSTRACT FROM AUTHOR]

Published
2023
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