Rationing in the Northern Ireland hospital sector

• Main Author: Smyth, Ursula Eimear
• Published: Queen's University Belfast 2017
• Subjects: 362.11
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.728663

This thesis through three interrelated research papers examines how to ration elective healthcare in the Northern Ireland hospital sector and investigates the policy option of waiting. Paper one contributes to knowledge on rationing in a healthcare setting by examining demand and supply rationing including the policy option of rationing by waiting. Paper one explores the key demand and supply drivers of waiting times in healthcare with specific focus on the hospital sector. Paper two makes an original contribution to the existing empirical knowledge on the demand and supply drivers of hospital waiting times by employing econometric analysis to estimate a waiting time equation, a demand equation and a supply equation for elective inpatient procedures for each of the twenty one key clinical specialties. Thirteen years of quarterly NHS hospital data (Quarter 1, 1995/1996 to Quarter 3,2007/2008) for Northern Ireland, is employed. The policy implication from the results in paper 2 is that a policy which may be effective for managing waiting times in one speciality may not be effective in other specialities. Paper three provides an original contribution to knowledge on healthcare rationing through an evaluation of the policy of a maximum waiting time guarantee in the Northern Ireland hospital sector. The evaluation includes quantitative and qualitative research. The qualitative study investigates the limitations of principal-agency theory when applied to healthcare. The research approach of grounded theory is employed to identify key themes from the ten hospital consultant and eleven hospital manager interviews undertaken to inform the research. The theme of professional power emerged from the study as significantly influencing the behaviour of the hospital consultants. It was also found that targets, the monitoring of performance and penalties for non-compliance will increase the success of a waiting time guarantee policy.