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Improving productive efficiency in hospitals: findings from a review of the international evidence

Published online by Cambridge University Press:  07 August 2014

Benedict E. Rumbold ,
Judith A. Smith ,
Jeremy Hurst ,
Anita Charlesworth  and
Aileen Clarke
Benedict E. Rumbold*
Affiliation:
Political Science, University College London, London, UK
Judith A. Smith
Affiliation:
The Nuffield Trust, London, UK
Jeremy Hurst
Affiliation:
Independent
Anita Charlesworth
Affiliation:
The Health Foundation, London, UK
Aileen Clarke
Affiliation:
Health Sciences, University of Warwick, Coventry, UK
*
*Correspondence to: Benedict E. Rumbold, School of Public Policy, The Rubin Building, 29/31 Tavistock Square, London WC1H 9QU, UK. Email: [email protected]
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Abstract

At present, health systems across Europe face the same challenges: a changing demographic profile, a rise in multi-morbidity and long-term conditions, increasing health care costs, large public debts and other legacies of an economic downturn. In light of these concerns, this article provides an overview of the international evidence on how to improve productive efficiency in secondary care settings. Updating and expanding upon a recent review of the literature by Hurst and Williams (2012), we set out evidence on potential interventions in the policy environment, hospital management, and operational processes. We conclude with five key lessons for policy makers and practitioners on how to improve productive efficiency within hospital settings, and identify several gaps in the existing evidence base.

Type
Overview
Information
Health Economics, Policy and Law , Volume 10 , Special Issue 1: SPECIAL ISSUE: Global Financial Crisis, Health and Health Care , January 2015 , pp. 21 - 43
Copyright
© Cambridge University Press 2014 

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References

Appleby, J. (1999), ‘Government funding of the UK National Health Service: what does the historical record reveal?’, Journal of Health Service Research and Policy, 4(2): 79–89.CrossRefGoogle ScholarPubMed
Appleby, J. (2008), ‘Scottish approach is not paying off’, Health Services Journal, 24: 19.Google Scholar
Barer, M. L., Evans, R. G., Hertzman, C. and Lomas, J. (1987), ‘Aging and health care utilization: new evidence on old fallacies’, Social Science and Medicine, 24(10): 851–862.CrossRefGoogle ScholarPubMed
Bazzoli, G. J., Lindrooth, R., Hasnain-Wynia, R. and Needleman, J. (2004–2005), ‘The Balanced Budget Act of 1997 and US hospital operations’, Inquiry, 41(4): 401–417.CrossRefGoogle Scholar
Beech, R. and Morgan, M. (1992), ‘Constraints on innovatory practice: the case of day surgery in the NHS’ International Journal of Health Planning and Management, 7(2): 133–148.Google ScholarPubMed
Berwick, D.M and Wald, D. L. (1990), ‘Hospital leaders’ opinions of the HCFA mortality data’ JAMA, 263(2): 247–249.CrossRefGoogle ScholarPubMed
Bevan, G. and Hood, C. (2006), ‘Have targets improved performance in the English NHS?’ British Medical Journal, 7538(332): 419–422.CrossRefGoogle Scholar
Bevan, G. and Skellern, M. (2011), ‘Does competition between hospitals improve clinical quality? A review of evidence from two eras of competition in the English NHS’, British Medical Journal, 343: d6470.CrossRefGoogle ScholarPubMed
Biørn, E., Hagen, T. P., Iversen, T. and Magnussen, J. (2002), The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores, 1992–2000, Working Paper 8, Health Economics Research Programme at the University of Oslo.Google Scholar
Black, N. (2012), ‘Declining health-care productivity in England: the making of a myth’, The Lancet, 379(9821): 1167–1169.CrossRefGoogle ScholarPubMed
Blank, J. L. and Van Hulst, B. L. (2009), ‘Productive innovations in hospitals: an empirical research on the relation between technology and productivity in the Dutch hospital industry’, Health Economics, 18(6): 665–679.CrossRefGoogle ScholarPubMed
Bloom, N. and Van Reenen, J. (2006), ‘Measuring and explaining management practices across firms and nations’, Center for Economic Performance, Discussion Paper no. 716.Google Scholar
Bloom, N., Propper, C., Seiler, S. and Van Reenen, J. (2010), ‘The impact of competition on management quality: evidence from public hospitals’, Discussion Paper 2010/09, Business School, Imperial College London.CrossRefGoogle Scholar
Buchan, J. and Calman, L. (2005), ‘Skill-mix and policy change in the health workforce: nurses in advanced roles’, OECD Health Working Papers No. 17, OECD, Paris.Google Scholar
Burns, L. R. and Muller, R. W. (2008), ‘Hospital-physician collaboration: landscape of economic integration and impact of clinical integration’, The Milbank Quarterly, 86(3): 375–434.CrossRefGoogle ScholarPubMed
Busse, R., Geissier, A., Quentin, W. and Wiley, M. (eds) (2011), Diagnosis-Related Groups in Europe, Maidenhead: McGraw-Hill and Open University Press.Google Scholar
Center for Medicare and Medicaid Services (2000), Review of assumptions and methods of the medicare trustees’ financial projections: technical review panel on the medicare trustees reports http://www.cms.hhs.gov/ReportsTrustFunds/02_TechnicalPanelReports.asp#TopOfPage [3 December 2013].Google Scholar
Clarke, A. (2002), ‘Length of in-hospital stay and its relationship to quality of care’, Quality & Safety in Health Care, 11(3): 209–210.CrossRefGoogle ScholarPubMed
Claxton, K. P., Martin, S., Soares, M. O., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P. C. and Sculpher, M. (2013), Methods for the estimation of the NICE cost effectiveness threshold: CHE Research Paper, Centre for Health Economics, 81. http://www.york.ac.uk/media/che/documents/reports/resubmitted_report.pdf [3 December 2013].Google Scholar
Connolly, S., Bevan, G. and Mays, N. (2010), Funding and Performance of Health care Systems in the Four Countries of the UK Before and After Devolution, London: The Nuffield Trust.Google Scholar
Cooper, Z., Gibbons, S., Jones, S. and McGuire, A. (2011), ‘Does hospital competition save lives? Evidence from the English NHS patient choice reforms’, The Economic Journal, 121: 554.CrossRefGoogle ScholarPubMed
De La Maisonneuve, C. and Oliveira Martins, J. (2013), ‘A projection method for public health and long-term care expenditures’, OECD Economics Department Working Papers No. 1048, OECD, Paris.CrossRefGoogle Scholar
European Commission (2014), European Economic Forecast: Spring 2014. Brussels: Economic and Financial Affairs Directorate General, European Commission. http://ec.europa.eu/economy_finance/publications/european_economy/2014/pdf/ee3_en.pdf [15 July 2014].Google Scholar
Fairhurst, P. and Reilly, P. (2010), Back Office Efficiency: Shared Services, London: NHS Confederation.Google Scholar
Farrar, S., Scott, A., Ikenwilo, D. and Chalkley, M. (2007), National Evaluation of Payment by Results. Report to the Department of Health, Aberdeen: Health Economics Research Unit, University of Aberdeen.Google Scholar
Fogel, P. (2004), Superior Productivity in Health Care Organisations: How to Get it, How to Keep it, Baltimore: Health Professions Press.Google Scholar
Fung, C., Lim, Y.-W., Mattke, S., Damberg, C. and Shekelle, P. (2008), ‘Systematic review: the evidence that publishing patient care performance data improves quality of care’, Annals of Internal Medicine, 148: 111–123.CrossRefGoogle ScholarPubMed
Garber, A. (2011), Competition, Integration and Incentives: The Quest for Efficiency in the English NHS, London: The Nuffield Trust.Google Scholar
Gaynor, M., Moreno-Serra, R. and Propper, C. (2011), DP8203 Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service. http://www.cepr.org/pubs/dps/DP8203.asp [15 July 2014].CrossRefGoogle Scholar
Hardie, M., Cheers, J., Pinder, C. and Qaiser, U. (2011), Public Service Output, Inputs and Productivity: Health care. Full Article, Newport: Office for National Statistics.Google Scholar
Hassan, E., Austin, C., Celia, C., Disley, E., Hunt, P., Marjanovic, S., Shehabi, A., Villalba-Van-Dijk, L. and Van Stolk, C. (2009), Health and Well-being at work in the United Kingdom, Santa Monica, California: The Work Foundation, RAND Europe and Aston Business School.Google Scholar
Hibbard, J. H. (2008), ‘What can we say about the impact of public reporting? Inconsistent execution yields variable results’, Annals of Internal Medicine, 148(2): 160–161.CrossRefGoogle ScholarPubMed
Hibbard, J. H., Greene, J., Sofaer, S., Firminger, K. and Hirsh, J. (2012), ‘An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care’, Health Affairs, 31(3): 560–568.CrossRefGoogle ScholarPubMed
HM Treasury (2009), Operational Efficiency Programme: Back Office Operations and IT, London: HM Treasury.Google Scholar
HM Treasury (2011), Public Expenditure Statistical Analyses 2011, London: HM Treasury.Google Scholar
Huerta, T., Ford, E., Peterson, I. and Brigham, K. (2008), ‘Testing the hospital value proposition: an empirical analysis of efficiency and quality’, Health Care Management Review, 33(4): 1–9.CrossRefGoogle ScholarPubMed
Hurst, J. and Williams, S. (2012), Can NHS Hospitals Do More With Less? London: Nuffield Trust.Google Scholar
Jiang, H., Bernard, F. and Begun, J. (2006a), ‘Factors associated with high-quality/low-cost hospital performance’, Journal of Health Care Finance, 32(3): 39–52.Google ScholarPubMed
Jiang, H., Bernard, F. and Begun, J. (2006b), ‘Sustaining and improving hospital performance: the effects of organizational and market factors’, Health Care Management Review, 31(3): 188–196.CrossRefGoogle ScholarPubMed
Jones, N. and Charlesworth, A. (2013), The Anatomy of Health Spending 2011–2, London: The Nuffield Trust.Google Scholar
Joumard, I., André, C. and Nicq, C. (2010), ‘Health care systems: efficiency and institutions’, OECD Economics Department Working Papers No. 769, Organisation for Economic Co-Operation and Development, Paris.Google Scholar
Kane, R., Shamliyan, T., Mueller, C., Duval, S. and Wilt, T. (2007), Nurse Staffing and Quality of Patient Care, Rockville, MD: US Agency for Health care Research and Quality.Google ScholarPubMed
Kimberly, J. R., de Pouvourville, G. and D’Aunno, T. (2008), The Globalization of Managerial Innovation in Health Care, Cambridge: Cambridge University Press.Google Scholar
Martinussen, P. and Midttun, L. (2004), ‘Day surgery and hospital efficiency’, Healthy Policy, 68: 183–196.CrossRefGoogle ScholarPubMed
Mehrotra, A., Damberg, C. L., Sorbero, M. E. S. and Teleki, S. S. (2009), ‘Pay for Performance in the hospital setting: what is the state of the evidence?’ American Journal of Medical Quality, 24(1): 19–28.CrossRefGoogle ScholarPubMed
National Audit Office (2011), Management of NHS Hospital Productivity HC491 Session 2010–11, London: National Audit Office.Google Scholar
Needleman, J., Buerhaus, P., Stewart, M., Zelevinsky, K. and Mattke, S. (2006), ‘Nurse staffing in hospitals: is there a business case for quality?’ Health Affairs, 25(1): 204–211.CrossRefGoogle Scholar
Newhouse, J. P. (1993), ‘An iconoclastic view of health cost containment’, Health Affairs, 12(Supplement): 152–171.CrossRefGoogle ScholarPubMed
NHS Institute for Innovation and Improvement (2006), Delivering Quality and Value: Focus on: Productivity and Efficiency, London: Department of Health.Google Scholar
NHS Institute for Innovation and Improvement (2009), Converting the potential into reality: 10 steps a provider can take to realise the benefits of better care, better value indicators www.institute.nhs.uk [15 July 2014].Google Scholar
OECD (2010), Health care systems: getting more value for money, OECD Economics Department Policy Notes, No. 2, OECD, Paris.Google Scholar
OECD (2012), Health at a Glance: Europe 2012, Paris: OECD.Google Scholar
OECD Website (2014), Glossary of statistical terms. http://stats.oecd.org/glossary/ [15 July 2014].Google Scholar
Orosz, E. and Morgan, D. (2004), SHA-based national health accounts in thirteen oecd countries: a comparative analysis, OECD Health Working Papers, No. 16, OECD Publishing. http://dx.doi.org/10.1787/131855120122 [3 December 2013].CrossRefGoogle Scholar
Pronovost, P., Angus, D., Dorman, T., Robinson, K., Dremsizov, T. and Young, T. (2002), ‘Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review’, Journal of American Medical Association, 288(17): 2151–2162.CrossRefGoogle ScholarPubMed
Propper, C., Burgess, S. and Gossage, D. (2008a), ‘Competition and quality: evidence from the NHS internal market 1991–9’, The Economic Journal, 118: 138–170.CrossRefGoogle Scholar
Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F. (2008b), ‘Did ‘Targets and Terror’ reduce waiting times in england for hospital care?’ The B.E. Journal of Economic Analysis & Policy, 8(2): ISSN 1935–1682.CrossRefGoogle Scholar
Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F. (2010), ‘Incentives and targets in hospital care: evidence from a natural experiment’, Journal of Public Economics, 94(3): 318–335.CrossRefGoogle Scholar
Rafferty, A., Clarke, S., Coles, J., Ball, J., James, P., McKee, M. and Aiken, L. (2007), ‘Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records’, International Journal of Nursing Studies, 44(2): 175–182.CrossRefGoogle ScholarPubMed
Robinson, S., Dickinson, H., Williams, I., Freeman, T., Rumbold, B. and Spence, K. (2011), A study of English Primary Care Trusts: Setting priorities in health, London: The Nuffield Trust.Google Scholar
Rosko, M. (2001), ‘Impact of HMO penetration and other environmental factors on hospital X-inefficiency’, Medical Care Research and Review, 58(4): 430–454.CrossRefGoogle ScholarPubMed
Rosko, M. (2004), ‘Performance of US teaching hospitals: a panel analysis of cost inefficiency’, Health Care Management Science, 7(7): 16.CrossRefGoogle ScholarPubMed
Rumbold, B., Alakesen, V. and Smith, P. C. (2012), Rationing Health Care: Is it Time to Specify What is Funded by the NHS? London: The Nuffield Trust.Google Scholar
Ryan, A. M. (2009), ‘Effects of the premier hospital quality incentive demonstration on medicare patient mortality and cost’, Health Services Research, 44(3): 821–842.CrossRefGoogle ScholarPubMed
Sassi, F. (2010), Obesity and the Economics of Prevention: Fit not Fat, Paris: OECD.CrossRefGoogle Scholar
Smith, S., Newhouse, J. P. and Freeland, M. S. (2009), ‘Income, insurance, and technology: why does health spending outpace economic growth?’ Health Affairs, 28: 1276–1284.CrossRefGoogle ScholarPubMed
Sutton, M., Nikolova, S., Boaden, R., Lester, H., McDonald, R. and Roland, M. (2012), ‘Reduced mortality with hospital pay for performance in England’, The New England Journal of Medicine, 367: 1821–1828.CrossRefGoogle ScholarPubMed
Tanenbaum, S. J. (2009), ‘Pay for performance in medicare: evidentiary irony and the politics of value’, Journal of Health Politics, Policy and Law, 34(5): 717–746.CrossRefGoogle ScholarPubMed
Valdmanis, V., Rosko, M. and Mutter, R. (2008), ‘Hospital quality, efficiency, and input slack differentials’, Health Services Research, 43(5): 1830–1848.CrossRefGoogle ScholarPubMed
Vina, E. R., Rhew, D. C., Weingarten, S. R., Weingarten, J. B. and Chang, J. T. (2009), ‘Relationship between organizational factors and performance among pay-for-performance hospitals’, Journal of General Internal Medicine, 24(7): 833–840.CrossRefGoogle ScholarPubMed
Walshe, K. (2011), ‘Managing Performance’, in K. Walshe and J. Smith (eds), Health care Management, Second Edition, Maidenhead: Open University Press.Google Scholar
Wennberg, J. (2011), ‘Time to tackle unwarranted variations in practice’, British Medical Journal, 342(7799): 687–690.CrossRefGoogle ScholarPubMed
World Health Organisation (WHO) (2000), The World Health Report 2000 – Health Systems: Improving Performance, Geneva: WHO.Google Scholar
World Health Organisation (WHO) (2005), Preventing Chronic Diseases: A Vital Investment, WHO Global Report, Geneva: WHO.Google Scholar
Zweifel, P., Felder, S. and Meiers, M. (1999), ‘Ageing of population and health care expenditure: a red herring?’, Health Economics, 8(6): 485–496.3.0.CO;2-4>CrossRefGoogle ScholarPubMed