Choices in Health Care: Waiting List, Rationing and Priorities

Abstract

The phenomenon of the waiting list is one of the most visible symptoms of scarcity of resources in health care. It is a very common experience for most citizens that they cannot immediately use the health care facilities when they are needed. Long waiting lists have become normal in many health care systems, particularly in Europe. However, waiting for appropriate treatment, diagnosis or care is also a source of deep concern. Individual patients may experience considerable stress or anxiety when they have to wait for treatment since they have a medical indication and are referred to specialist care. Patients may also suffer from uncertainty when they cannot have the diagnostic examination when there is a suspicion that they have a serious disease. Family systems may break down because of psychological burdens when the condition of the mentally handicapped child or the dementing parent they are caring for is deteriorating and the waiting lists for admission to professional facilities are very long. Furthermore, waiting lists are a source of frustration for health care professionals; they cannot provide the treatment and care that is indicated on medical criteria. Waiting lists give also rise to public concern and political debate, particularly when they have negative consequences, such as patients on the waiting list who died before they could receive adequate treatment, or serious accidents in private homes or in neighbourhoods which could have been avoided with earlier placement of a demented person in nursing home.