Waiting times in health care - Finland

Mika Gissler, Pirjo Häkkinen and Petri Matveinen

Health care guarantee

• Introduced in health care legislation in 2005

• Included in the current Health Care Act 2011

• Maximum waiting times for non-emergency care:

– Immediate contact with primary health care

– Assessment by healthcare professional in 3 days

– Assessment by specialist in 3 weeks

– Treatment in 3 months (may be extended to 6 months)

– Referred patients assessed in 3 weeks

– Consultations, special imaging, lab tests in 3 months

• National criteria for access to non-emergency care

Monitoring and supervision

• Municipalities and hospital districts obliged to report data to the National Institute for Health and Welfare, THL

• Data about access to primary health care, dental care, and specialised care compiled by THL

– Similar data collection in social welfare services

– New data collection on cancer care

• Hospital districts supervised by VALVIRA National Supervisory Authority for Welfare and Health

– Cut-off values for substandard performance

– Threat of economic sanctions (adjusted to the size of the hospital district)

Supervision by TEO (2008) and VALVIRA (2009-2014)

Order Penalty payment

Threat Request for payment

– 2008 25 5 -

– 2009 2 1 -

– 2010 7 2 -

– 2011 5 1 -

– 2012 1 - -

– 2013 - - -

– Oct 2014 1 1 -

Primary health care

• Previously the data were collected separately from health care centres.

• Since 1 January 2014, the data collection is based on: – a separate questionnaire to the chief physicians on health

care centres

• contact to primary health care and reporting on access to care

• N=150, 93% participation rate in March 2014

– the continuously collected Primary Health Care Register (AvoHILMO)

• reliable information from 87% of health care centres.

Immediate contact with primary health care, %?

Continuous

problems

Some

problems

No

problems

Waiting time to physician, in days

• In March 2014, less than half of non-urgent visits to

physician in primary health care occurred within one week

after first contact.

• In 15% of cases, the waiting time was more than 30 days.

• 83% reports waiting time every 4 months, as requested by

the law. No reporting at all: 3%.

Waiting time to nurse, in days

• In most of cases, non-urgent visits to nurse in primary

health care occurred within one week after first contact.

• In 7% of cases, the waiting time was more than 30 days

and in 2% more than 90 days.

Specialised health care

• The data are collected separately from central hospital district (20) and the health care centres providing specialised health care services (25).

– Three times a year

– Waiting time in general and non-urgent surgical procedures

• OECD Health Data for the requested procedures are taken from Care Register for Health Care Institutions

Waiting time for first visit more than 90 days, % 2007–2012

0

5

10

15

20

25

30

35

%

Waiting time more than 21 days for referrals to specialised health care 1.1.–31.8.2014 by central hospital district

Waiting time more than 90 days for evaluation of need of care in specialised health care 31.8.2014 by central hospital district

OECD Health Data – waiting time for cataract surgery, days

OECD Health Data – waiting time for PTCA, days

OECD Health Data – Patients waiting more than 3 months, %

Discussion – conclusions

• Maximum waiting times guarantee enforced by legislation and (threat of) disciplinary sanctions has been associated with shorter waiting times to hospital care.

• Not possible to evaluate the size of the effect

– Other developments in the health sector

– Problems with monitoring

• Rubber banding vs. permanent changes?

• What is the total impact of criteria for access to non-emergency care?

Waiting time to dentist, in days

• According to register information from 91 heath care centres,

96% of visits occurred within three months after the first

contact to health care centre.

• In 4% the waiting time was 91-180 days.

• 83% reports waiting time every 4 months, as requested by the

law. No reporting at all: 2%.

KL/JAH 30.12.2009

© Kuntarajat: Tilastokeskus

Sairaanhoidon erityisvastuualueet ja sairaanhoitopiirit:

Keskussairaaloiden sijaintikunnat

HYKS erva

KYS erva

OYS erva

TAYS erva

TYKS erva

Etelä-Karjala (EK)

Etelä-Pohjanmaa (EP)

Etelä-Savo (ES) Itä-Savo (IS)

Kainuu (KAI)

Kymenlaakso (KYM)

Varsinais-Suomi (VS)

Päijät-Häme (PH)

Pohjois-Karjala (PK)

Pohjois-Savo (PS)

Keski-Suomi (KS)

Pirkanmaa (P)

Vaasa (V)

Keski-Pohjanmaa (KP)

Pohjois-Pohjanmaa (PP) Länsi-Pohja (LP)

Satakunta (S)

Kanta-Häme (KH)

Lappi (L)

Helsinki ja Uusimaa (HUS)

EK

ES IS

KYM

PK

PP

L

LP

PS KP

KAI

V

EP KS

HUS

PH KH

P S

VS

336 municipalities, 20 hospital districts, 5 regions

Referrals 1.1.–31.8.2014 by central hospital district waiting time more than 21 days

SAIRAANHOITOPIIRIT Lähetteet

yhteensä, lkm

Lähetteitä käsitelty

yhteensä, lkm

Lähete käsitelty 3 vrk:ssa, lkm

Lähete käsitelty 4-21 vrk:ssa, lkm

Lähete käsitelty yli 21 vrk:ssa,

lkm

Lähete käsitelty yli 21

vrk:ssa, %

Lähete käsitelty, odostusajan

mediaani, vrk

Helsingin ja Uudenmaan shp 213 913 210 624 140 236 64 113 6 275 3,0 2

Lapin shp 0 17 377 10 900 6 113 364 2,1 2

Pirkanmaan shp 48 258 48 618 38 464 9 657 497 1,0 1

Pohjois-Savon shp 35 549 35 688 23 434 11 943 311 0,9 2

Varsinais-Suomen shp 47 166 47 451 33 621 13 453 377 0,8 1

Pohjois-Pohjanmaan shp 43 023 43 562 30 087 13 130 345 0,8 2

Satakunnan shp 25 077 24 832 17 952 6 671 209 0,8 1

Vaasan shp 0 20 295 15 352 4 772 171 0,8 1

Etelä-Savon shp 15 458 15 311 12 976 2 207 128 0,8 1

Itä-Savon shp 7 641 7 565 6 786 725 54 0,7 1

Keski-Pohjanmaan shp 13 305 13 445 8 552 4 814 79 0,6 2

Keski-Suomen shp 34 438 34 390 31 915 2 319 156 0,5 1

Etelä-Pohjanmaan shp 30 734 30 572 22 949 7 482 141 0,5 1

Kymenlaakson shp 18 458 18 458 16 863 1 511 84 0,5 0

Etelä-Karjalan shp 12 066 12 059 10 889 1 120 50 0,4 1

Kainuun shp 11 527 11 525 10 024 1 457 44 0,4 0

Kanta-Hämeen shp 23 037 22 811 21 230 1 508 73 0,3 1

Länsi-Pohjan shp 8 336 8 482 6 634 1 825 23 0,3 0

Päijät-Hämeen shp 0 23 994 22 515 1 420 59 0,2 1

Pohjois-Karjalan shp 22 320 22 316 18 135 4 145 36 0,2 1

Yhteensä 610 306 669 375 499 514 160 385 9 476 1,4 -

Waiting time for most common treatments in specialised health care 31.8.2014

Jonoryhmä Yhteensä,

lkm

1-90 vrk,

lkm

91-180 vrk,

lkm

Yli 180 vrk,

lkm

Yli 180 vrk,

%

Yli 90 vrk,

lkm

Yli 90 vrk,

%

Kaihileikkaus 9 994 5 531 4 227 236 2,4 4 463 44,7

Polven tai lonkan tekonivelleikkaus 3 638 2 297 1 261 80 2,2 1 341 36,9

Nivus-, napa- ja arpityräleikkaukset 1 994 1 422 530 42 2,1 572 28,7

Ruokatorven, mahalaukun ja suoliston

tähystykset 1 035 948 75 12 1,2 87 8,4

Rannekanava-ahtauman leikkaus 1 021 781 236 4 0,4 240 23,5

Suonikohjujen hoito 969 590 348 31 3,2 379 39,1

Sappileikkaus 914 648 251 15 1,6 266 29,1

Olkapään tähystykset ja leikkaukset 903 644 255 4 0,4 259 28,7

Gynekologiset laskeumaleikkaukset 826 498 325 3 0,4 328 39,7

Polvinivelen tähystykset ja leikkaukset 765 586 169 10 1,3 179 23,4

Kohdunpoisto 746 526 217 3 0,4 220 29,5

Kaula- tai selkärangan luudutusleikkaus 706 423 238 45 6,4 283 40,1

Isovarpaan tyvinivelen ongelmien leikkaus 680 463 208 9 1,3 217 31,9

Rintarauhasen pienennys- tai

muovausleikkaus 557 261 230 66 11,8 296 53,1

Käden pehmytkudosleikkaus 538 346 184 8 1,5 192 35,7

Sepelvaltimoiden kuvaukset 523 431 91 1 0,2 92 17,6

Nenän sivuonteloiden leikkaukset 519 331 188 0 0,0 188 36,2

Eturauhasen liikakasvun toimenpiteet 503 365 131 7 1,4 138 27,4

Kitarisaleikkaukset ja tärykalvon

putkitukset 468 425 41 2 0,4 43 9,2

Kilpirauhasleikkaukset 394 257 128 9 2,3 137 34,8

Ranne- ja käsinivelen muovaus- tai

luudutusleikkaus 379 221 150 8 2,1 158 41,7

Hampaiden poistoleikkaukset 258 187 66 5 1,9 71 27,5

Naisen virtsankarkailuleikkaus 257 170 85 2 0,8 87 33,9

Peräpukamaleikkaus 211 128 81 2 0,9 83 39,3

Rytmihäiriöiden hoito 198 123 52 23 11,6 75 37,9

Sepelvaltimoiden ohitusleikkaus 93 77 16 0 0,0 16 17,2

Sepelvaltimoiden pallolaajennus tai stentti 52 48 4 0 0,0 4 7,7

Yhteensä 29 141 18 727 9 787 627 2,2 10 414 35,7