Towards a macro model of National Health Service waiting lists

Abstract

Waiting lists for elective surgery have been endemic to the UK National Health Service since its inception in 1948. The lists arise as a result of interaction between supply factors (the provision of resources and the efficiency of their use) and demand factors (arising from a complex conjunction of the perceptions and preferences of patients and physicians). This article takes the first steps towards the development of a macro model of the NHS waiting list. It adopts an economics perspective and assumes that the waiting time for surgery, as perceived by patients, physicians and managers, is a central influence on the quantity of elective surgery demanded and supplied. Using the methods of system dynamics, econometric results are integrated into a dynamic model that seeks to illustrate the path taken over time by the national system of elective surgery. It explores a number of future scenarios, and finds that the NHS will quickly cease to be a universal service if resources fail to keep pace with increases in demand. Copyright © 1999 John Wiley & Sons, Ltd.