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Priority access to health care: Evidence from an exogenous policy shock.

ABSTRACT: Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients-established patients and new patients. We exploit an exogenous policy change-implemented by the U.S. Veterans Health Administration-that removed the disparity and homogenized the wait time. We find strong evidence that without such a policy, established patients have priority access over new patients. We discuss whether this is a suboptimal allocation of resources. We additionally find that established patient priority access is an important determinant of access for new patients; accounting for it increased the explanatory power of our statistical model of new patient wait times by a factor of five. The findings imply that policy and management decisions may be more effective in achieving the optimal distribution of access if access heterogeneity is recognized and accounted for explicitly.

SUBMITTER: Yee CA

PROVIDER: S-EPMC8284942 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Priority access to health care: Evidence from an exogenous policy shock.

Yee Christine A CA Legler Aaron A Davies Michael M Prentice Julia J Pizer Steven S

Health economics 20200130 3

Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients-established pat ...[more]

PMID: 31999884

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Project description:BackgroundEffective integration of evidence and youth perspectives into policy is crucial for supporting the future health and well-being of young people. The aim of this project was to translate evidence from the Access 3 project to support development of a new state policy on youth health and well-being within New South Wales (NSW), Australia. Ensuring the active contribution of young people within policy development was a key objective of the knowledge translation (KT) process.MethodsThe KT activity consisted of a 1-day facilitated forum with 64 purposively sampled stakeholders. Participants included eight young people, 14 policy-makers, 15 academics, 22 clinicians or managers from NSW health services, four general practitioners and one mental health service worker. Research to be translated came from the synthesized findings of the NSW Access 3 project. The design of the forum included stakeholder presentations and group workshops, guided by the 2003 Lavis et al. KT framework that was improved by the Grimshaw et al. KT framework in 2012. Members of the Access 3 research team took on the role of knowledge brokers throughout the KT process. Participant satisfaction with the workshop was evaluated using a brief self-report survey. Policy uptake was determined through examination of the subsequent NSW Youth Health Framework 2017-2024.ResultsA total of 25 policy recommendations were established through the workshop, and these were grouped into six themes that broadly aligned with the synthesized findings from the Access 3 project. The six policy themes were (1) technology solutions, (2) integrated care and investment to build capacity, (3) adolescent health checks, (4) workforce, (5) youth participation and (6) youth health indicators. Forum members were asked to vote on the importance of individual recommendations. These policy recommendations were subsequently presented to the NSW Ministry of Health, with some evidence of policy uptake identified. The majority of participants rated the forum positively.ConclusionsThe utilization of KT theories and active youth engagement led to the successful translation of research evidence and youth perspectives into NSW youth health policy. Future research should examine the implementation of policy arising from these KT efforts.

Project description:BackgroundThis study aims to assess preferences and values for priority setting in healthcare in Chile through an original and innovative survey method. Based on the answers from a previous survey that look into the barriers the Chilean population face, this study considers the preferences of the communities overcoming those barriers. As a result six programs were identified: (1) new infrastructure, (2) better healthcare coverage, (3) increasing physicians/specialists, (4) new informatics systems, (5) new awareness healthcare programs, and (6) improving availability of drugs.MethodsWe applied an innovative survey method developed for this study to sample subjects to prioritize these programs by their opinion and by allocating resources. The survey also asked people's preferences for a distributive justice principle for healthcare to guide priority setting of services in Chile. The survey was conducted with a sample of 1142 individuals.ResultsMore than half of the interviewees (56.4%) indicated a single program as their first priority, while 20.1% selected two of them as their first priority. To increase the number of doctors/specialists and improve patient-doctor communication was the program that obtained the highest priority. The second and third priorities correspond to improving and investing in infrastructure and expanding the coverage of healthcare insurances. Additionally, the results showed that equal access for equal healthcare is the principle selected by the majority to guide distributive justice for the Chilean health system.ConclusionsThis study shows how a large population sample can participate in major decision making of national health policies, including making a choice of a distributive justice principle. Despite the complexity of the questions asked, this study demonstrated that with an innovative method and adequate guidance, average population is capable of engaging in expressing their preferences and values. Results of this study provide policy-makers useful community generated information for prioritizing policies to improve healthcare access.

Dataset Information

Priority access to health care: Evidence from an exogenous policy shock.

Publications

Priority access to health care: Evidence from an exogenous policy shock.

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