Abstract
Prolonged waiting times and extensive queues for elective surgeries have been persistent issues in many publicly funded health systems. The COVID-19 pandemic has worsened this problem, leading to the widespread cancellation or postponement of scheduled operations globally. Recognising the urgent need to address these escalating waiting times and alleviate the strain on both patients and health systems, collaboration with the private sector might be a viable strategy in certain contexts. This systematic review aims to compile research evidence on public-private partnerships specifically designed to reduce waiting times for elective surgeries. Our objective is to provide valuable insights to policymakers, guiding them in formulating effective initiatives and interventions to alleviate longstanding patient backlogs. This paper focuses on reviewing the impact of outsourcing elective surgical services to private for-profit (PFP) providers, with a particular emphasis on time-related variables. We searched PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library up to January 2020, for articles published after 2013 and updated the search in November 2021. The primary focus of our investigation centered on studies examining the impact of outsourcing elective surgical services with the explicit aim of reducing waiting times on public sector elective surgical lists. Eligible studies included those pertaining to major elective surgeries conducted on adult patients. The review was registered in PROSPERO under the identifier CRD42019158455, and we employed the relevant Critical Appraisal Skills Programme (CASP) tool to assess the quality of evidence in the identified studies. The electronic search yielded 7543 records and five studies were eligible after deduplication and full article screening. One study of moderate quality examines the cost implications of a competitive tendering model, and the other four studies are considered low quality due to unaddressed biases in their methodologies. The eligible research varied widely in design, scope, and reported outcomes. Because of heterogeneity, we did a meta-synthesis with narrative analysis. The findings of this review indicate that, particularly for certain elective surgeries like hip and knee replacements, outsourcing to private sector providers appears to be associated with a reduction in waiting times and an enhancement of patient access. This becomes particularly important in the context of the intensified waiting lists for elective surgeries due to the impact of COVID-19. The potential advantages of outsourcing elective surgical procedures to private providers extend beyond shortened waiting times and increased access, encompassing aspects such as cost-effectiveness, optimised utilisation of existing spare capacity, and enhanced collaboration between the public and private sectors within the healthcare system. However, it is crucial to note that these potential benefits necessitate further formal assessment, and regulatory processes are essential to ensure the maintenance of both equity and quality of care. While the evidence drawn upon in this review predominantly relies on observational studies, preventing precise conclusions, the identified patterns and insights offer valuable foundations for the design of future interventional studies. The exploration of these constructs can potentially guide the development of more targeted and effective strategies for addressing elective surgery backlogs and improving overall healthcare delivery.