EFFECT OF FUNDHOLDING ON WAITING-TIMES - DATABASE STUDY

Objectives: To determine whether fundholding patients have shorter wai ting times for surgery than non-fundholding patients and to establish if any such differences resulted from practices attaining fundholding status. Design: Comparison of waiting times of fundholding and non-fun dholding patients for elective surgery covered by the fundholding sche me at four providers over four years. Comparison of the waiting times for patients of practices in their last par outside and first year ins ide the fundholding scheme with those for patients of practices remain ing non-fundholding. Setting: West Sussex. Subjects: Over 57 000 patie nts on the elective waiting list who had operations purchased by a hea lth authority or fundholding practice during 1992-6. Patients with boo ked or planned elective admissions were excluded. Main outcome measure s: Waiting times for patients of fundholding and non-fundholding patie nts. Results: Patients of fundholding practices had significantly shor ter waiting times than those of non-fundholders for all four providers and over all four years. Waiting times for patients did not fall unti l the year that the practices joined the fundholding scheme. Conclusio ns: Fundholding shortens waiting times. This may be because purchasing of elective surgery is best done at a practice level or because fundh olding practices are funded overgenerously.