Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-12-01T02:13:52.527Z Has data issue: false hasContentIssue false
  • English
  • Français

Getting out what we put in: productivity of the English National Health Service

Published online by Cambridge University Press:  28 October 2010

Adriana Castelli ,
Mauro Laudicella ,
Andrew Street  and
Padraic Ward
Adriana Castelli
Affiliation:
Centre for Health Economics, University of York, Heslington, York, UK
Mauro Laudicella
Affiliation:
Centre for Health Economics, University of York, Heslington, York, UK
Andrew Street*
Affiliation:
Centre for Health Economics, University of York, Heslington, York, UK
Padraic Ward
Affiliation:
Centre for Health Economics, University of York, Heslington, York, UK
*
Correspondence to: Andrew Street, Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Many countries are incorporating direct measures of non-market outputs in the national accounts. For any particular output to be included there has to be data about it for two adjacent periods. This is problematic because the classification of non-market outputs is often subject to wholesale revision. We outline the challenges associated with classification changes and propose a solution. To illustrate we construct output and input indices and estimate productivity growth of the English National Health Service (NHS) for the period 2003–2004 to 2007–2008. Our index of output growth incorporates all care provided to NHS patients and captures improvements in survival rates, waiting times and disease management. We find that more patients are being treated and the quality of the care they receive has been improving. We implement our approach to dealing with changes as to how health services are defined and show what effect this has on estimates of output growth. Our index of input growth captures all labour, intermediate and capital inputs into health service production and we improve on how capital has been measured in the past. Inputs have increased over time but there has also been a slowdown since 2005–2006, primarily the result of a levelling off in staff recruitment and less reliance on the use of agency staff. Productivity is assessed by comparing output growth with growth in inputs, the net effect being constant productivity growth between 2003–2004 and 2007–2008.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 3 , 16 June 2011 , pp. 313 - 335
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Casemix Service (2008), HRG version 3.5 & HRG4 Comparative Chapter Analysis, Leeds.Google Scholar
Castelli, A., Dawson, D., Gravelle, H., Street, A. (2007), ‘Improving the measurement of health system output growth’, Health Economics, 16: 1091–1107.CrossRefGoogle ScholarPubMed
Castelli, A., Laudicella, M., Street, A. (2008), ‘Measuring NHS Output Growth’, Centre for Health Economics Research Paper 43, York.Google Scholar
Cutler, D. M., McClellan, M., Newhouse, J. P.Remler, D. (2001), ‘Pricing heart attack treatments’, in D. M. Cutler and E. R. Berndt (eds), Medical Care Output and Productivity, Chicago, IL: University of Chicago Press, 305–362.CrossRefGoogle Scholar
Dawson, D., Gravelle, H., O’Mahony, M., Street, A., Weale, M., Castelli, A., Jacobs, R., Kind, P., Loveridge, P., Martin, S., Stevens, P., Stokes, L. (2005), ‘Developing New Approaches to Measuring NHS Outputs and Productivity’, Final Report, Centre for Health Economics Research Paper 6, York.Google Scholar
Derbyshire, K., Zerdevas, P., Unsworth, R., Haslam, M. (2007), Further Developments in Measuring Quality Adjusted Healthcare Output, Leeds: Department of Health.Google Scholar
Eurostat (1995), European Systems of Accounts, Luxembourg: Office for Official Publications of the European Communities.Google Scholar
Eurostat (2001), Handbook on Price and Volume Measures in National Accounts, Luxembourg: Office for Official Publications of the European Communities.Google Scholar
Eurostat/Commission of the European Communities, International Monetary Fund, Organisation for Economic Co-Operation and Development, United Nations and the World Bank (1993), System of National Accounts 1993, Brussels: European Communities/Eurostat, IMF, OECD, United Nations and World Bank.Google Scholar
Fenty, J., Coupland, C., Hippisley-Cox, J.Gravelle, H. (2006), Determinants of Consultation Rates Over Time: Implications for Estimating the National Volume of Consultations, Nottingham: QRESEARCH University of Nottingham.Google Scholar
Healthcare Commission (2007), Independent Sector Treatment Centres: A Review of the Quality of Care, London: Commission for Healthcare Audit and Inspection.Google Scholar
Lakhani, A., Coles, J., Eayres, D., Spence, C.Rachet, B. (2005), ‘Creative use of existing clinical and health outcomes data to assess NHS performance in England: part 1-performance indicators closely linked to clinical care’, British Medical Journal, 330: 1426–1431.CrossRefGoogle ScholarPubMed
Lee, P. (2006), Public Service Productivity: Health, London: Office of National Statistics.Google ScholarPubMed
Mason, A., Street, A.Verzulli, R. (2010), ‘Private sector treatment centres are treating less complex patients than the NHS’, Journal of the Royal Society of Medicine, 103: 322–331.CrossRefGoogle ScholarPubMed
Office for National Statistics (ONS) (2008), Sources and Methods for Public Service Productivity: Health, London: ONS.Google Scholar
Office for National Statistics (ONS) (2009a), Health Care Output 1995–2007, London: ONS.Google Scholar
Office for National Statistics (ONS) (2009b), Public Service Output, Input and Productivity: Health Care Output, London: ONS.Google Scholar
Oulton, N. (2001), ‘Measuring capital services in the United Kingdom’, Bank of England Quarterly Bulletin, Autumn: 295–309.Google Scholar
Oulton, N. (2005), Ex post Versus ex Ante Measures of the User Cost of Capital, London: Centre for Economic Performance.Google Scholar
Oulton, N.Srinivasan, S. (2003), Capital Stocks, Capital Services, and Depreciation: An Integrated Framework, London: Bank of England.Google Scholar
Pike, R. (2008), ‘Measuring inflation’, Economic and Labour Market Review, 2: 59–60.CrossRefGoogle Scholar
Pont, M. (2008), ‘Improvements to the measurement of government output in the national accounts’, Economic and Labour Market Review, 2: 17–22.CrossRefGoogle Scholar
Street, A.Ward, P. (2009), ‘NHS Input and Productivity Growth 2003/4–2007/8’, Centre for Health Economics Research Paper 47, York.Google Scholar
The Information Centre (2007a), General Ophthalmic Services: Activity Statistics for England and Wales, Leeds: The Information Centre.Google Scholar
The Information Centre (2007b), ‘NHS Dental Activity and Workforce Report England’, 31 March 2006, The Information Centre, Leeds.Google Scholar
Wallis, G. (2005), ‘Estimates of the volume of capital services’, Economic Trends, 624: 42–51.Google Scholar
Willmer, R.Little, C. (2007), Review of Data Sources and Methodology for the Calculation of Hospital Output in the NHS, London: Department of Health.Google Scholar
Zerdevas, P. (2009), Purchase Of Health Care From Non NHS Bodies, Leeds: Department of Health.Google Scholar