scholarly journals Private general paediatric care availability in Melbourne

2017 ◽  
Vol 41 (1) ◽  
pp. 63 ◽  
Author(s):  
Marina Kunin ◽  
Amy R. Allen ◽  
Caroline Nicolas ◽  
Gary L. Freed
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Metropolitan Region ◽  
Specialist Care ◽  
Paediatric Care ◽  
Average Potential ◽  
General Paediatrician ◽  
Appointment Availability ◽  
The Cost ◽  
Potential Maximum

Objective The aims of the present study were to determine the actual availability of private general paediatric appointments in the Melbourne metropolitan region for children with non-urgent chronic illnesses and the cost of such care. Methods A ‘secret shopper’ method was used. Telephone calls were made to a random sample of 47 private paediatric clinics. A trained research assistant posed as a parent, requesting the first available appointment with a specific paediatrician. Data regarding appointment availability, total potential charges and net charges after the Medicare rebate were collected. Results Appointments were available in 79% (n = 37) of clinics, with 72% (n = 34) able to offer an appointment with the requested general paediatrician. The number of days until available appointments varied from same day appointments to a wait of 124 days, with an average wait of 33 days. Of practices that provided information about the appointment cost (n = 42), five bulk-billed for the consultation, whereas the remainder (n = 37) were fee-paying clinics. The potential maximum charge for an initial consultation in the fee-paying clinics ranged from A$177 to A$430, with an average cost of A$279. The potential maximum out-of-pocket cost for patients ranged from A$40 to A$222, with an average out-of-pocket cost of A$128. Conclusions Private paediatric care in the Melbourne metropolitan region is generally available. The out-of-pocket cost of private paediatric out-patient care may present a potential economic barrier for some families. What is known about the topic? In Australia, out-of-pocket expenses for private specialist care are not covered by private health insurance. There are no data available on the actual cost of private paediatric consultations that are based on real-time assessments. Data collected in 1998 suggested that the average waiting time for a first standard consultation with a general paediatrician in a private room was 14.1 days. There are no recent empirical data on appointment availability and waiting time for appointments with general paediatricians in Australia. What does this paper add? There is high availability of paediatric consultations in the private sector. Waiting times for an appointment vary considerably from same day appointments to a wait of 124 days, with an average wait of 33 days. The cost of a private paediatric consultation in Australia to the patient is considerable, with an average potential maximum up-front charge for an initial consultation of A$279 and an average potential maximum out-of-pocket cost of A$128. What are the implications for practitioners? Data on the availability and cost of private paediatric consultations are imperative to formulate evidence-informed policy and better understand variations in the availability of public and private care.

Cost of Waiting, Risk, and Individual Action: The Case of Public Housing

1984 ◽  
Vol 2 (3) ◽  
pp. 307-324 ◽  
Author(s):  
K G Willis
Keyword(s):  
Public Housing ◽  
Waiting Time ◽  
Risk Premium ◽  
Time Preference ◽  
Waiting Times ◽  
Individual Action ◽  
Alternative Housing ◽  
Time Estimates ◽  
Time Preference Rate ◽  
The Cost

In this paper the concept of waiting time for public housing is explored; the individual's decisionmaking process on whether to join the housing queue is modeled; how long he/she is prepared to wait for public housing is assessed; a methodology to evaluate the cost of this waiting time is proposed; and estimates of some likely values of this cost are made. The cost of waiting is of more than esoteric interest, impinging on several questions of policy, such as the use of waiting times as indicators in assessing need, the sale of council housing, and the efficiency of a nonprice method of resource allocation. The model predicts the maximum length of time a person will be prepared to wait, given his/her life expectancy in the authority's house, the relative cost to the person of alternative housing, and his/her time-preference rate. Risk preferences are also incorporated to assess the ‘risk premium’: The extra cost a person would sacrifice to be certain of obtaining public housing at a specified time. Estimates of the cost of waiting are derived from the model and also from a questionnaire survey of housing waiting-list applicants in North Tyneside Metropolitan Borough.

scholarly journals SPECIAL CONSIDERATION ON THE DESIGN OF AN LNG HARBOR

1974 ◽  
Vol 1 (14) ◽  
pp. 150
Author(s):  
Bernard Le Mehaute
Keyword(s):  
Interest Rates ◽  
Waiting Time ◽  
Closed Loop ◽  
Waiting Times ◽  
Single Point ◽  
Open Loop ◽  
Loop Theory ◽  
Cryogenic Pump ◽  
Optimum Solution ◽  
The Cost

One of the primary considerations in the design of an LNG harbor is safety, requiring berths to be separated by large distance and well protected from the outside wave agitation. Therefore, LNG harbors require expensive structures established as close as possible to the liquefaction plant (while crude tankers may be served by relatively much cheaper, single point mooring servers in deeper water). The cost of waiting time for the very expensive LNG ships has to be weighted against the cost of the additional berths and structures. (A 125, 000 m-^ LNG ships costs $2000/hour. ) The present paper describes the results of a study in which the optimum solution has been obtained by comparing these costs. The number of options is characterized by the number of berths. The cost to be added to the cost of construction of the berths includes an additional length of breakwater and additional dredging, plus the costs of financing during construction and the cost of maintenance. The waiting time for the LNG ship is generally determined, based on the classical Erlang formula for quelng theory. It is recalled that this formula is developed for an open loop. A closed loop theory has been specially developed for the present problem (since LNG ships will most probably operate between two well-defined harbors). The waiting times are 15 to 20% smaller than given by the closed loop theory. A comparison between single berth and double berth is examined. The effect of the rate of filling which is a function of the cryogenic pump capacity (or size of ship depending upon the dominating controlling factor) is analyzed. Finally, the sensitivity of the recommended solution as a function of the interest rates--examined in view of current economic uncertainties--is also investigated. The final recommendation for the design of the harbor, based on the prevailing factors, is the optimum economic solution.

scholarly journals Challenges to ensuring valid and useful waiting time monitoring – a qualitative study in Swedish specialist care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Ebbevi ◽  
Henna Hasson ◽  
Knut Lönnroth ◽  
Hanna Augustsson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Waiting Time ◽  
Waiting Times ◽  
Policy Issue ◽  
Face Validity ◽  
Care Providers ◽  
Specialist Care ◽  
Time Data ◽  
Administrative Management

Abstract Background Access to health care is an essential health policy issue. In several countries, waiting time guarantees mandate set time limits for assessment and treatment. High-quality waiting time data are necessary to evaluate and improve waiting times. This study’s aim was to investigate health care providers and administrative management professionals’ perceptions of validity and usefulness of waiting time reporting in specialist care. Methods Semi-structured interviews (n = 28) were conducted with administrative management and care professionals (line managers and care providers) in specialized clinics in the Stockholm Region, Sweden. Clinic-specific data from the waiting time registry was used in the care provider interviews to assess face validity. Clinics were purposefully sampled for maximum variation in complexity of care, volume of production, geographical location, private or public ownership, and local waiting times. Thematic analysis was used. Results The waiting time registry was perceived to have low validity and usefulness. Perceived validity and usefulness were interconnected, with mechanisms that reinforced the connection. Structural and cognitive barriers to validity included technical and procedural errors, errors caused by role division, misinterpretation of guidelines, diverging interpretations of nonregulated cases and extensive willful manipulation of data. Conclusions We identify four misconceptions underpinning the current waiting time reporting system: passive dissemination of guidelines is sufficient as implemented, cognitive load of care providers to report waiting times is negligible, soft-law regulation and presentation of outcome data is sufficient to drive improvement, and self-reported data linked to incentives poses a low risk of data corruption. To counter low validity and usefulness, we propose the following for policy makers and administrative management when developing and implementing waiting time monitoring: communicate guidelines with instructions for operationalization, address barriers to implementation, ensure quality through monitoring of implementation and adherence to guidelines, develop IT ontology together with professionals, avoid parallel measurement infrastructures, ensure waiting times are presented to suit management needs, provide timely waiting time data, enable the study of single cases, minimize manual data entry, and perform spot-checks or external validity checks. Several of these strategies should be transferable to waiting time monitoring in other contexts.

scholarly journals Interhospital referral of colorectal cancer patients: a Dutch population-based study

2021 ◽  
Author(s):  
A. K. Warps ◽  
◽  
M. P. M. de Neree tot Babberich ◽  
E. Dekker ◽  
M. W. J. M. Wouters ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Waiting Time ◽  
Secondary Care ◽  
Advanced Disease ◽  
Waiting Times ◽  
Tertiary Care ◽  
Disease Stage ◽  
Colorectal Cancer Patients ◽  
Tertiary Care Hospitals

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

scholarly journals E-Triage Systems for COVID-19 Outbreak: Review and Recommendations

Sensors ◽  
2021 ◽  
Vol 21 (8) ◽  
pp. 2845
Author(s):  
Fahd Alhaidari ◽  
Abdullah Almuhaideb ◽  
Shikah Alsunaidi ◽  
Nehad Ibrahim ◽  
Nida Aslam ◽  
...  
Keyword(s):  
Population Growth ◽  
Disease Severity ◽  
Waiting Time ◽  
Transmission Rate ◽  
Waiting Times ◽  
Triage System ◽  
Disease Symptoms ◽  
Comprehensive Review ◽  
Severity Levels ◽  
Growth And Aging

With population growth and aging, the emergence of new diseases and immunodeficiency, the demand for emergency departments (EDs) increases, making overcrowding in these departments a global problem. Due to the disease severity and transmission rate of COVID-19, it is necessary to provide an accurate and automated triage system to classify and isolate the suspected cases. Different triage methods for COVID-19 patients have been proposed as disease symptoms vary by country. Still, several problems with triage systems remain unresolved, most notably overcrowding in EDs, lengthy waiting times and difficulty adjusting static triage systems when the nature and symptoms of a disease changes. In this paper, we conduct a comprehensive review of general ED triage systems as well as COVID-19 triage systems. We identified important parameters that we recommend considering when designing an e-Triage (electronic triage) system for EDs, namely waiting time, simplicity, reliability, validity, scalability, and adaptability. Moreover, the study proposes a scoring-based e-Triage system for COVID-19 along with several recommended solutions to enhance the overall outcome of e-Triage systems during the outbreak. The recommended solutions aim to reduce overcrowding and overheads in EDs by remotely assessing patients’ conditions and identifying their severity levels.

493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat ◽  
E Kinene ◽  
S Molloy
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Time Frame ◽  
Outpatient Clinics ◽  
Contributing Factors ◽  
Time Data ◽  
Work Related ◽  
Mean Waiting Time ◽  
Appointment Time ◽  
Related Stress

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.

Some general results for many server queues

1973 ◽  
Vol 5 (01) ◽  
pp. 153-169 ◽  
Author(s):  
J. H. A. De Smit
Keyword(s):  
Integral Equations ◽  
Waiting Time ◽  
Queue Length ◽  
Joint Distribution ◽  
Waiting Times ◽  
Virtual Waiting Time ◽  
Server Queue ◽  
Many Server Queues ◽  
The Many ◽  
Busy Cycle

Pollaczek's theory for the many server queue is generalized and extended. Pollaczek (1961) found the distribution of the actual waiting times in the model G/G/s as a solution of a set of integral equations. We give a somewhat more general set of integral equations from which the joint distribution of the actual waiting time and some other random variables may be found. With this joint distribution we can obtain distributions of a number of characteristic quantities, such as the virtual waiting time, the queue length, the number of busy servers, the busy period and the busy cycle. For a wide class of many server queues the formal expressions may lead to explicit results.

HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

2002 ◽  
Vol 18 (3) ◽  
pp. 611-618
Author(s):  
Markus Torkki ◽  
Miika Linna ◽  
Seppo Seitsalo ◽  
Pekka Paavolainen
Keyword(s):  
Hallux Valgus ◽  
Waiting Time ◽  
Varicose Vein ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting List ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Potential Problems ◽  
Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

scholarly journals Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong

2009 ◽  
Vol 16 (3) ◽  
pp. 148-154 ◽  
Author(s):  
CA Graham ◽  
WO Kwok ◽  
YL Tsang ◽  
TH Rainer
Keyword(s):  
Health Care ◽  
Hong Kong ◽  
Health Care Providers ◽  
Waiting Time ◽  
Health Care Professionals ◽  
Waiting Times ◽  
Medical Advice ◽  
Care Providers ◽  
Convenience Sample ◽  
Waiting Area

Objective To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED. Methods The study recruited 249 semi-urgent and non-urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire. Results From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal-Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%). Conclusion Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.

scholarly journals National and regional trends in MRI utilization in the face of the ongoing COVID-19 pandemic

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Osnat Luxenburg ◽  
Mor Saban ◽  
Vicki Myers ◽  
Sharona Vaknin ◽  
Noga Boldor ◽  
...  
Keyword(s):  
Waiting Times ◽  
National Level ◽  
Metropolitan Region ◽  
Third Wave ◽  
Policy Makers ◽  
Unequal Distribution ◽  
Elective Surgical Procedures ◽  
Regional Trends ◽  
The Face ◽  
Magnetic Resonance Imaging Mri

Abstract Background and purpose Marked reductions in imaging exams have been documented during the COVID-19 pandemic. The study aimed to examine the effect of the two waves of COVID-19 on magnetic resonance imaging (MRI) utilization at the national and regional level. Materials and methods A retrospective-archive study was conducted in Israel, comparing March–December 2020 with March–December 2018 and 2019. Data on MRI utilization were obtained from the national MRI registry, while data on confirmed COVID-19 cases, by place of residence, were obtained from the Israeli Ministry of Health open COVID-19 database. Results The number and rate of MRI examinations decreased during the first COVID-19 wave, with the steepest drop in April 2020: 47.5% relative decrease compared to April 2019, and 42.2% compared to 2018. This was followed by a compensatory increase between the waves and a return to almost pre-pandemic levels of use, with just a modest decrease, during the second, more intense COVID wave, compared with the previous year. Existing differences between regions increased during the pandemic. The rate ratio of MRI exams between Tel-Aviv and the Northern periphery increased from 2.89 in April 2019 to 3.94 in April 2020. Jerusalem metropolitan region, with the largest burden of COVID disease, demonstrated only a modest decrease (1%) in MRI utilization during the first 10 months of the pandemic. Conclusions At the national level, time trends in reduced MRI utilization followed the first wave of COVID-19, and were accompanied by increased regional disparities. These changes were not explained by differences in the burden of COVID-19 disease but might be explained by unequal distribution of MRI scanners among regions. Reduced utilization was not evident during the second wave, nor at the beginning of the third wave, despite higher COVID-19 case load, demonstrating adaptation to the new normal. Patterns of MRI utilization might help policy-makers and healthcare managers predict the behavior of imaging as well as other sectors, such as elective surgical procedures, during an ongoing pandemic. This forecast might help to manage the lasting effects of the pandemic, including extended waiting times, in the months and years following its remission. In preparation for future national emergencies, timely and detailed data on MRI utilization can serve as a “sensor” for a wide array of diagnostic and interventional medical activities, providing policy-makers with an updated snapshot to guide their response at the regional and national levels.

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