OBJECTIVES:

This study analyses the potential discrimination in access to scheduled surgery in the Portuguese National Health Service (NHS), measured in waiting times. Since the cancellation rate is around 14%, we decided to include both operated and cancelled episodes.

METHODS:

We used about 3 million observations from 2011 to 2015 and estimated several survival models (Exponential, Weibull and Piecewise exponential models) with right-censored data to explain waiting times, based on gender, surgical procedure, patient’s age, patient’s cancer indicator, municipality, hospital, speciality, year, and patient’s priority. To our knowledge, there are no previous studies on waiting times for scheduled surgery that use an extensive database and include cancellations as well as survival models. In addition, we observe in more detail the motivations for cancellation and identify groups potentially vulnerable to cancellations.

RESULTS:

The results show that men are more likely to be operated, and consequently, have shorter waiting times. Likewise, patients with more severe health conditions, as the patients reported with cancer, have a higher likelihood of surgery. Patients under one-year-old present a higher probability of operation, and, on the other side, the likelihood of surgery gradually decreases after age 40.

We found some interesting patterns in what concerns the competing risks for cancellation. Although men have a higher likelihood of operation, their probability of cancellation is even greater. The main reasons are the loss of the clinical condition and death. Another noteworthy result is that patients with an oncological indicator are more likely to cancel due to death (higher than the likelihood of operation).

CONCLUSIONS:

These findings suggest the need for measures more focused on certain groups of patients to increase the probability of surgery, reduce their exposure to the various kinds of cancellations, and increase equity in the Portuguese NHS.