Bed capacity and surgical waiting lists: a simulation analysis

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Manel Antelo
Francisco Reyes Santias
Adela Martinez Calvo


Waiting time for elective surgery is a key problem in the current medical world. This paper aims to reproduce, by a Monte Carlo simulation model, the relationship between hospital capacity, inpatient activity, and surgery waiting list size in teaching hospitals. Inpatient activity is simulated by fitting a Normal distribution to real inpatient activity data, and the effect of the number of beds on inpatient activity is modelled with a linear regression model. Analysis is performed with data of the University Multi-Hospital Complex of Santiago de Compostela (Santiago de Compostela, Spain), by considering two scenarios regarding the elastiticity of demand with bed increase. If demand does not grow with an increase on bed capacity, small changes lead to drastic reductions in the waiting lists. However, if demand grows as bed capacity does, adding additional capacity merely makes waiting lists worse.

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Author Biography

Manel Antelo, Universidad de Santiago de Compostela

Departamento de Fundamentos da Análise Económica, Universidade de Santiago de Compostela, Campus Norte, 15782 Santiago de Compostela, Spain


Akkerman, Renzo and Marrig Knip (2004) ‘Reallocating of beds to reduce waiting time for cardiac surgery’, Health Care Management Science 7(2): 119-126.

Alvarez, Adriana M. and Martha Centeno (1999) Enhancing simulation models for emergency rooms using VBA, Winter Simulation Conference, 1685-1693.

Churruca, Silvia (2000) ‘Los líderes en gestión de listas de espera advierten: un suceso no puede condicionar la estrategia’, Diario Médico, 15/06/2000. Available at (last accessed September 2000).

Commonwealth Fund (1997), Leveling the Playing Field: Financing theMissions of Academic Health Centers, Report of the Commonwealth Fund Task Force on Academic Health Centers New York: Commonwealth Fund, May.

Denton, Brian, James Viapiano and Andrea Vogl (2007) ‘Optimization of surgery sequencing and scheduling decisions under uncertainty’, Health Care Management Science 10(1): 13-24.

Everett, Jeffrey E. (2002) ‘A decision support simulation model for the management of an elective surgery waiting system’, Health Care Management Science 5(2): 89-95.

Hurst, Jeremy and Luigi Siciliani (2003) Tackling excessive waiting times for elective surgery: a comparison of policies in twelve OECD countries, OECD Health Working Paper, No. 6.

Kirtland, Anthony, Karen Poisker, Linda Stamp and Patricia Wolfe (1995), Simulating an ED ‘is as much fun as?’, Proceedings of Winter Simulation Conference, C. Alexopoulos, K. Kang, W.R. Lilegdon and D. Goldsman (eds.), Institute of Electrical and Electronics Engineers, Washington, 1039-1042.

Koenig, Lane, Allen Dobson, Silver Ho, Jonathan M. Siegel, Daniel S. Blumenthal and Joel S. Weissman (2003) ‘Estimating The Mission-Related Costs Of Teaching Hospitals’, Health Affairs 22(6): 112-122.

Kroneman, Madelon and Jacques J. Siegers (2004) ‘The effect of hospital bed reduction on the use of beds: A comparative study of 10 European countries’, Social Science & Medicine 59(8): 1731-1740.

Lapierre, Sophie D. and Angel B. Ruiz (2007) ‘Scheduling logistic activities to improve hospital supply systems’, Computers and Operations Research 34(3): 624-641.

Law, Averill M. (1983) ‘Statistical analysis of simulation output data’, Operations Research 31(6): 983–1029.

Law, Averill M. and W. David Kelton (1991) Simulation Modelling and Analysis, McGraw-Hill, New York, 2nd ed.

Lindsay, Cotton M. and Bernard Feigenbaum (1984) ‘Rationing by waiting lists’, American Economic Review 74(3): 404-417.

Martin, Stephen and Peter C. Smith (1999) ‘Rationing by waiting lists: an empirical investigation’, Journal of Public Economics 71(1): 141-64.

R Development Core Team, R (2010), A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria. (Available at <>.)

Roemer, Milton I. (1961) ‘Bed supply and hospital utilization: A natural experiment’, Hospitals 35, 988-993.

Sampietro, Laura and Mireia Espallargues (2001) ‘Nuevas fórmulas para dar solución a las listas de espera’, El Médico, 15 june of 2000: 60-64.

Shain, Max and Milton I. Roemer (1959) ‘Hospital costs relate to the supply of beds’, Modern Hospital 92(4): 71-73.

Siciliani, Luigi and Jeremy Hurst (2003), Explaining waiting times variations for elective surgery across OECD countries, OECD Health Working Papers 7.

Silber Sigmund, H. Mühling, R. Dörr, G. Zindler, A. Preuss and A. Stümpfl (1996) ‘Waiting times and death on the waiting list for coronary artery bypass operation. Experiences in Munich with over 1,000 patients’, Herz 21(6): 389-396.

Street, Andrew and Stephen Duckett (1996) ‘Are waiting lists inevitable?’ Health Policy 36(1): 1-15.

VanBerkel, Peter T. and John T. Blake (2007) ‘A comprehensive simulation for wait time reduction and capacity planning applied to general surgery’, Health Care Management Science 10(4): 373-385.

Wand, M.P. and M.C. Jones (1995), Kernel Smoothing, Chapman & Hall, London.

Wilson, J.C. Tunnicliffe (1981) ‘Implementation of computer simulation projects in health care’, Journal of the Operational Research Society 32(9): 825–832.

Yamaguchi Naoito, Tomohide Tamura, Tomotaka Sobue, Suminori Akiba, Megu Ohtaki, Yoshinobu Baba, Shigeto Mizuno and Shaw Watanabe (1994) ‘Evaluation of Cancer prevention strategies by computerized simulation model: Methodological issues’, Environmental Health Perspectives 102, Suppl. 8, 64-71.

Zeraati, Hojjat, Farid Zayeri, Gholamreza Babae, Navid Khanafshar and Fatemeh Ramezanzadeh (2005) ‘Required hospital beds estimation: A simulation study’, Journal of Applied Sciences 5(7): 1189-1191.