[Evaluation of a program for reducing the surgical waiting list on the basis of on the spot payment]

Abstract

Background: The aim of this study was to evaluate a program to shorten the surgical waiting list on the basis of on the spot payment for each intervention performed outside the ordinary time schedule. The evaluation was based on preestablished hypothesis concerning the possible beneficial and adverse effects of on the spot payment.

Methods: Eighty-four units corresponding to 6 surgical specialties in 14 hospitals of the Valencian Public Health Care Department were included in the study. The effects of this program were compared between the units which carried out the program from March to June 1992 (experimental group: EG) and the units which did not undertake the program (control group: CG).

Results: The interventions performed in the program constituted 31% of the initial waiting list of the EG units. Bed profitability increased in the EG with surgeon productivity decreasing within the ordinary time schedule in the units of general surgery in the EG (16%) and the selection of diagnoses did not coincide with clinical priorities (positive selection of fimosis, fallopian tube tieing and negative selection of goiter and prostatic hyperplasia).

Conclusions: The design of programs based on the spot payment should take the possible adverse effects into account establishing mechanisms to avoid the decrease in ordinary activity and the selection of patients on the basis of criteria different to clinical priorities.