EVALUATION OF A PROGRAM OF REDUCTION IN T HE SURGICAL WAITING LIST ONTHE BASIS OF THE SPOT PAYMENT

BACKGROUND: The aim of this study was to evaluate a program to shorten the surgical waiting list on the basis of on the spot payment for eac h intervention performed outside the ordinary time schedule. The evalu ation was based on preestablished hypothesis concerning the possible b eneficial and adverse effects of on the spot payment METHODS: Eighty-f our units corresponding to 6 surgical specialities in 14 hospitals of the Valencian Public Health Care Department were included in the study . The effects of this program were compared between the units which ca rried out the program from March to June 1992 (experimental group: EG) and the units which did not undertake te program (control group: CG). RESULTS: The interventions performed in the program constituted 31% o f the initial waiting list of the EG units. Bed profitability increase d in the EG with surgeon productivity decreasing within the ordinary t ime schedule in the units of general surgery in the EG (16%) and the s election of diagnoses did not coincide with clinical priorities (posit ive selection of fimosis, fallopian tube tieing and negative selection of goiter and prostatic hyperplasia). CONCLUSIONS: The design of prog rams based on the spot payment should take the possible adverse effect s into account establishing mechanisms to avoid the decrease in ordina ry activity and the selection of patients on the basis of criteria dif ferent to clinical priorities.