Health service costs for patients on the waiting list.

OBJECTIVE To find out if the cost of health services was artificially increased because of a delay in surgery due to a lack of resources. DESIGN A retrospective cohort study. SETTING Three urban hospitals in Calgary, Alta. PATIENTS The study cohort comprised 4441 patients (1 index procedure for each patient). INTERVENTIONS Cholecystectomy, discectomy, hysterectomy, total knee and total hip replacements. OUTCOME MEASURES The costs for physician claims, use of home care and pharmaceutical prescriptions 1 year before and after the selected procedures, using 1997/98 administrative records and waiting times maintained by Alberta Health and Wellness and Calgary Regional Health Authority. RESULTS The median wait for joint surgery (88 d for knee replacements and 65 d for hip replacements) was longer than for the other selected procedures (29 d for cholecystectomies, 21 d for discectomies and 42 d for hysterectomies). Total per patient physician claim costs decreased after surgery (cholecystectomy--30%, discectomy--24%, hip replacement--6%, hysterectomy--23% and knee replacement--4%). Seeing the procedure specialist more than once preoperatively was associated with a greater decrease in postoperative physician claim costs. Longer waits were not associated with more physician claim costs or Blue Cross prescriptions claim costs for seniors (> or = 65 yr) in the year before or after surgery nor were they associated with more physician claim costs during the actual wait compared with a matched postoperative time period. CONCLUSIONS No evidence was found to suggest that waiting for 1 of 5 common surgical procedures is correlated with greater health service expenditures pre- or postoperatively. In this study, wait time is not a proxy for health service use nor do health service costs decrease markedly after surgery.