Surfing between the National Health Service and private spending: Impacts on waiting times for cancer admissions

This study investigates whether so-called “surfing” between the National Health Service (SSN) and private spending can reduce waiting times for oncological hospitalizations, potentially undermining the principle of equity in access to care.The objective is to verify whether, despite the mix between public and private spending, the SSN is able to guaranteeequitable access and comprehensive care for critical treatment pathways, such as oncological surgical interventions, where waiting times can significantly impactclinical outcomes.The study focuses on a cohort of 41,408 scheduled oncological hospitalizations during the 2022-2023 period and analyzes the preoperative diagnostic services required for inclusion on the surgical waiting list, provided under the SSN or through private channels (distinguished among public or accredited private providers operating both in public and private settings and private providers authorized to operate solely in the private sector). The analysis shows that 68.4% of preoperative services were provided under the SSN, 12.1% under the intramural private practice system or through the solvency area of public or accredited private providers contracted with the regional health service (SSR), and 19.5% were paid directly by patients or through private insurance to authorized private providers exclusively offering private services, with a higher incidence of reliance on solvency in accredited private facilities compared to public ones.The results indicate that patients who access all preoperative services privately benefit from shorter waiting times compared to those accessing only through the SSN, while patients who “surf” do not appear to gain significant advantages.Overall, the system seems to maintain an acceptable equity profile, with limited distortions in total waiting times. The study concludes that reliance on private solvency has a limited impact on waiting times for oncological patients, while highlighting the need for stricter regulations to ensure equitable access to critical preoperative services.

Keywords: ; Oncological admissions; Waiting times; Equity of access

Antonio Giampiero Russo, Walter Bergamaschi, Francesco Longo, Surfing tra SSN e spesa privata: impatti sui tempi di attesa dei ricoveri oncologici in "MECOSAN" 129/2024, pp 109-128, DOI: 10.3280/mesa2024-129oa18976