International comparisons of waiting times for cardiovascular procedures: A commentary on the long queue

Waiting times for important and resource-intensive cardiovascular procedures have become a popular index for assessing the degree of rationing of medical care that is perceived to exist within various nationally subsidized health care systems.Until the health care reform debate took a repose, pro tern, in the summer/autumn of 1994, the U.S. citizenry had been exposed to extensive coverage in the news media of the long waiting times for medical services that go hand in hand with socialized medicine.Perhaps the most frequently cited examples of such rationing are the "excessive" waiting times for coronary bypass surgery in Canada and the United Kingdom.Indeed, these queues are so long that a substantial number of Canadians cross the border to have their bypass surgery on a more timely basis within the U.S. private payer system.Such an exodus, along with certain polls (1), is frequently cited as reflecting the great discontent that exists within countries that provide health care through a national health care service.Although these systems offer universal access from "cradle to grave," the message appears to be that they are largely wanting because limited budgets and finite resources ultimately require rationing of services.For those who so argue, long queues for such important procedures as coronary revascularization are considered the most visible evidence of wrongful rationing.Present study.Carroll et al.(2) pick up on this theme in this issue of the Journal.Their study was designed to compare waiting times for cardiac catheterization and coronary bypass procedures in five different health care delivery/financing systems.The U.S. non-Veterans Affairs (VA) hospitals represent the pleuralistic, free-market model, whereas the U.S. Veterans Affairs hospitals and hospitals in Sweden, the United Kingdom and Canada are examples of federally funded national health services.The methodology used was a questionnaire response to four hypothetical case scenarios that were