Prioritising waiting lists: how and why?

Recent years have seen increasing interest in waiting-list prioritisation systems in a number of countries, although such systems have a long history. Critical analysis demonstrates that these systems appear to have a range of sometimes conflicting, but often insufficiently articulated, objectives – both political and clinical. For some greater consistency and transparency is the prime objective, whilst for others the aim appears to be to override clinical priorities. Whilst the objectives should determine both the functional forms adopted and which elements are included, the findings suggest this is not necessarily the case and, further, that this is not always appreciated by users. It is concluded that objectives must be clearly identified and models developed which address those objectives both in their form and content. OR has an important role both in the development of such systems and in ensuring their implications are fully understood.