Understanding Waiting Times for Health Care

In Sunday’s New York Times, reporter Elizabeth Rosenthal discusses evidence that that waiting times for medical care in the United States do not always compare favorably with those of other developed countries:

“I fully expect wait times to be going up this year for Medicaid and Medicare and private insurance because we are expanding access to care, but we’re not really expanding the system of providers,” said Steven D. Pizer, a health care economist at Northeastern University in Boston.

Unfortunately, the article evolves into an apologetic for waiting times as a good thing. I would also quibble with Ms. Rosenthal’s description of U.S. health care as “market-based,” which it certainly is not. I don’t think I’ve met anyone, pro- or anti-Obamacare, who does not expect waiting times to increase as long as Obamacare exists. So, we better get used to them. How to explain them?

First, it is surely the case that a little waiting might be beneficial. This is often alluded to in articles like Ms. Rosenthal’s, but only conceptually. Seldom do surveys actually compare experienced waiting times with medically appropriate waiting times. One that does is the Fraser Institute’s survey of waiting times in Canada, which finds that experienced waiting times do, indeed, exceed medically appropriate waiting times in that single-payer system. The Fraser Institute has also detected a negative effect on mortality.

Second, patient surveys are somewhat perilous. The Fraser Institute surveys doctors, not patients. There are a few disadvantages to surveying patients: Their recall may be faulty, their expectations vary, and their definition of “waiting time” may not be consistent. For example, a patient in Canada may not bother to seek an appointment with a specialist immediately when his family doctor recommends one, because he knows it is hopeless. Instead, he and his family doctor will use their networking skills to identify a likely opportunity. For example, a friend of mine in Toronto helped a friend of his get an appointment with a specialist, because my friend’s daughter and the specialist’s daughter attend the same private school. So, he can short circuit the “system” to help his friend. His friend will not report a long wait when surveyed. His family doctor, however, will report a long wait.

Third, even if patients report accurately, they may actually be demanding too much health care relative to the supply, but the supply may more than adequate for actual medical needs. This may explain what is happening in the Boston area, where waiting times are much longer than elsewhere in the United States. Obviously, there is no shortage of excellent physicians and hospitals in Boston. However, Massachusetts has had mandatory health insurance for a few years now, so the state has artificially stimulated demand. Under Governor Patrick, the state has begun an exercise in seeking to control costs by artificially constraining supply.

One thing we can say for certain about waiting lists is that we will be talking about them a lot more in the years to come.

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For the pivotal alternative to Obamacare, please see the Independent Institute’s widely acclaimed book: Priceless: Curing the Healthcare Crisis, by John C. Goodman.