Dear Un-Economist: I am sick and tired of waiting three hours just to see the doctor for three minutes. Frankly, I have better things to do with my time.
Dear Sick and Tired: Perhaps you should use some of that time to make an appointment. That way, it’s probably a ten-minute wait at most for, say, five minutes of examination, prescription, and maybe a little doctorly advice. Still, sitting around in those dreary hospital lobbies with all those other harried, germy patients can be a real drag. But what if I told you that much of what looks like an interminable waiting line is a mirage, and that, more importantly, forcing patients to wait actually makes economic sense?
First of all, the line is usually not as long as it looks, since the patients waiting in a single lobby will be called into any one of many rooms that line the lobby and adjacent corridors, each room holding a doctor*. Divide the number of patients in the lobby by the number of active booths, and you get the true length of the average “waiting” line**. In short, it’s never as bad as it looks. With that, let’s move on to what I think is the more important part of my argument: waiting lines make economic sense.
Let’s say that a hospital doctor has an eight-hour working day. Of that, let’s say that she uses half that time for other chores and toilet breaks and whatnot, so she has four hours to actually treat patients. Let’s now assume that she takes ten minutes on average to treat a patient, five minutes of face time and five more to prepare and process the case. This means that she can treat 60÷10×4=24 patients per day. Now at one end, the hospital can have all the patients seeking treatment from her line up in the morning, let her go through as many as she can, then have her come back the next day and repeat the sequence, and so on. This would not pose much of a problem if the patients were like damaged autos brought in for repair, but they have a life. At the other end, the hospital could employ enough comparable doctors to ensure that no patient has to wait at any time, but that would leave many doctors idle for much if not most of the time, sending the cost of the treatment through the roof.
What hospitals (and individual doctors) can and apparently do is something that falls between those two extremes. They take appointments and squeeze in patients without appointments where sufficient slack arises. Another option would be to allocate certain hours to patients without an appointment on a first-come-first-served basis. Either way, waiting lines will not be eliminated for patients without an appointment. Moreover, given the variance in the time required to treat individual patients, even patients with appointments will often have to wait in line. But something or other along these lines should go a long ways in easing the waiting line problem, as this real-life example shows.
Now some patients will say, wait a minute, I’m a lawyer, my opportunity cost is $500 an hour, I can’t afford to wait. These people can take their business out of the public healthcare system (although they will still have to pay into one or other public healthcare system) by paying for the full cost of a pricey on-demand service. I suspect that this is the kind of clientele that those extravagant Ginza clinics cater to. And if you’re really, really wealthy, I suppose that you can employ a personal physician, or even furnish a personal clinic, if you wish. These are also perfectly sensible market solutions.
In sum, it is clear that the waiting line is an economically rational means that ordinary hospitals use to maximize efficiency on the supply side by imposing opportunity costs on the demand side, but that the opportunity costs can be reduced by using an appointment system. So is it functioning? Well, to the best of my knowledge, hospitals do manage to clear their waiting lines by the end of the working day. So I can’t say that it’s broken by any means.
* If you’re a guy and this reminds you of what I think it reminds you of, then I think you need to take a cold shower.
** Note that a large number of those patients may have already seen the doctor and are waiting for their documents to be processed. But this is the same waiting line problem being replicated at the administrative level, so it poses the same resource allocation issues. Accordingly, it can be left out of this particular argument without any significant loss.
Still can’t say that I’ve 100% nailed it, so it should be going to Globaltalk 21 Raw for more polishing, but what can you expect from an Un-Economist?
There is an oft-repeated argument that old people visiting hospitals because there is no place else to go. Some people believe that this problem has eased considerably since co-payment requirements were reintroduced for the elderly. I may come back to this point on a later occasion.