Equal waiting times for all? Empirical evidence for elective surgeries in the Austrian public healthcare system

Objectives
This study analyses waiting times for elective surgeries and potential determinants, including supplementary private health insurance, visits in the operating physician's private practice and informal payments for faster treatment.

Study design
Retrospective patient questionnaire survey.

Methods
The survey was conducted in eleven Austrian rehabilitation centres in 2019. Data was analysed based on bivariate tests (n = 400) and a multivariate negative-binomial regression model (n = 310) with institution- and patient-related characteristics as independent variables.

Results
Median waiting times were 8.9 weeks (IQR: 4.5–18.0) for hip replacement and 8.4 weeks (IQR: 5.0–20.0) for knee replacement surgery. 10.9% of the patients reported having received an offer to shorten their waiting time through a visit in the operating physician's private practice before the surgery or through an informal payment directly to the operating physician. Surgery in private for-profit hospitals, supplementary private health insurance and severe pain were associated with shorter waiting times.

Conclusions
While waiting times for elective surgeries in Austria are below international levels, shorter waits for patients with private health insurance and offers to reduce waiting times through informal payments point to equitable access concerns in a public healthcare system.