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J Health Econ. 2015 May;41:72-88. doi: 10.1016/j.jhealeco.2015.02.001. Epub 2015 Feb 14.

Do maximum waiting times guarantees change clinical priorities for elective treatment? Evidence from Scotland.

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Academic Unit of Health Economics, Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, University of Leeds, Leeds LS2 9LJ, UK. Electronic address:
Economics, School of Social Sciences, Arthur Lewis Building, Oxford Road, University of Manchester, Manchester M13 9PL, UK. Electronic address:
Manchester Centre for Health Economics, Institute of Population Health, Jean McFarlane Building, Oxford Road, University of Manchester, Manchester M13 9PL, UK. Electronic address:


The level and distribution of patient waiting times for elective treatment are a major concern in publicly funded health care systems. Strict targets, which have specified maximum waiting times, have been introduced in the NHS over the last decade and have been criticised for distorting existing clinical priorities in scheduling hospital treatment. We demonstrate the usefulness of conditional density estimation (CDE) in the evaluation of the reform using data for Scotland for 2002 and 2007. We develop a modified goodness of fit test to discriminate between models with different numbers of bins. We document a change in prioritisation between different patient groups with longer waiting patients benefiting at the expense of those who previously waited less. Our results contribute to understanding the response of publicly funded health systems to enforced targets for maximum waiting times.


Conditional density estimation; Management of waiting lists; Maximum waiting times reform; Patient prioritisation; Public health systems

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