Differences in waiting times for elective admissions in NSW public hospitals: A decomposition analysis by non-clinical factors. CHERE Working Paper 2010/7

In the Australian public health system, access to elective surgery is rationed through provision of health care services, it is generally assumed that a patient?s waiting time and locations. In this paper we undertake Oaxaca-Blinder and DiNardo-Fortin-Lemieux decompostition analyses to attribute variation in waiting time to a component explained by clinical need and to differential treatment effects. The latter have an interpretation as discrimination, since treatments vary by non-clinical factors such as socioeconomic status. Using data from public patients in NSW public hospitals in 2004-2005, we find socioeconomically advantaged patients, patients in remote areas, and patients in several Area Health Services have shorter waiting times than their clinical comparable counterparts. Furthermore, the discrimination effect dominates clinical admission if their treatments are delayed. This finding has policy implications for the current operation of waiting lists and order of admission and for the design of equitable quality targets for public hospitals.