Improving access to surgery during and after the COVID-19 pandemic: A systematic review of the effects of outsourcing elective surgeries to private-sector health service providers to shorten waiting times

Background Waiting times are a key performance indicator for many healthcare systems, which are used with the aim of delivering high-quality care without unnecessary delay. Long waiting times and lengthy queues for elective surgery have been common to many publicly funded health systems for some time but the impact of the COVID-19 pandemic has led to large numbers of scheduled operations being cancelled or postponed globally. Among multiple strategies that might help ease the burden of these even longer waiting times on patients and health systems, collaboration with the private sector has been reported as effective in certain settings. Therefore, this review assesses the evidence on the effects on waiting times of outsourcing elective surgical services to private sector service providers. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library up to January 2020, for articles published after 2013 and updated the search on November 2021. Eligibility criteria included major elective surgery for adult patients. Both randomised trials and non-randomised controlled studies were considered for the review and the main outcome variable of interest was waiting time for elective surgery. The quality of evidence was assessed using the relevant CASP tool and the review is presented as a narrative synthesis because of heterogeneity in the methods of the included studies. The review was registered in PROSPERO (CRD42019158455). Results The electronic search yielded 7543 records and seven studies were eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality. Conclusions The evidence from this review suggests that for certain types of elective surgeries, such as hip and knee replacement, outsourcing to private sector providers is likely to shorten waiting times and increase access for patients. This may be especially important given the impact of COVID-19 on elective surgery waiting lists. The limitations identified due to observational study methods could be overcome by interventional studies and we recommend randomised trials coupled with economic analysis to determine the trade-offs between time, cost and quality of care.