Since Israel’s National Health Insurance Law went into force in 1995, policymakers have been concerned about the negative impact of long waiting times for community-based specialty care on eventual service provision. From the clinical perspective, long waiting times for community-based specialty care are liable to have harmful consequences for health. From the system perspective, long waiting times are likewise undesirable as they increase the likelihood of medical complications and even hospitalization, increasing the system total health expenditures. Private expenditure on health care services is also increased as a result since many patients seeking to shorten waiting times opt for private health care services.
This study is part of a national project for measuring waiting times for community-based specialty care, led by the Ministry of Health.
- To examine the perceptions of health plan members regarding waiting times for community-based specialty care and the experience of members from their own perspective.
- To characterize the conduct of health plan members and the factors influencing them when making an appointment for specialty care.
- To understand the dynamics of arranging a visit to a specialist physician and to identify barriers to appointment setting with the aim of shortening waiting times.
A telephone survey among Israeli residents aged 22 and over at the time the survey was conducted (from August 2019 to February 2020). To ensure representation of major population groups (Arabs and Jews), a hierarchical stratified sampling strategy was used, with a 28% oversampling of the Arab population. A questionnaire was developed specifically for this survey, which examined the experience of the patient waiting for community-based specialty care. The questionnaire included questions about the perceived waiting time and its acceptability from the patient’s perspective as well as questions about the patient’s decision making at various stages in the appointment setting process and the visit to the specialist physician. 3,751 interviewees responded to the 20-minute-long telephone survey (a response rate of 59%).
The majority of respondents who sought specialty care services in the preceding six months had visited a specialist physician or were waiting for a scheduled appointment with one. Only a few respondents never tried to schedule an appointment, tried but failed to schedule an appointment, or failed to show up for the scheduled appointment. Background characteristics (socio-economic, demographic, and health characteristics) had an effect on the pathway followed by a person seeking specialty care and on the experience he/she went through in each case. The average waiting time for an appointment with a specialist physician was 31 to 83 days (depending on the pathway). About half of the respondents with a scheduled appointment thought that the waiting time for the appointment was reasonable or very reasonable. It was also found that a long waiting time for community-based specialty care was the most common reason for seeking private specialty care (including through supplementary health insurance)
Summary and Action Items
Waiting times for community-based specialty care are one of the quality indicators of the national health care system that are monitored and published by the Ministry of Health. They should thus be measured on an ongoing basis and made available to the public. In addition to the objective measurement, the experience of members of the national health plans seeking specialty care should also be continuously measured as it is one of the key factors that determine the course of action they will opt for – waiting for the scheduled appointment, seeking private specialty care, or foregoing specialty care altogether. In view of the current public discourse on the reform designed to shorten waiting times for health care services, further research is called for regarding waiting times for elective surgical procedures in hospitals and various imaging tests.