IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v22y2013i2p194-211.html
   My bibliography  Save this article

Regional Variation In The Productivity Of The English National Health Service

Author

Listed:
  • Chris Bojke
  • Adriana Castelli
  • Andrew Street
  • Padraic Ward
  • Mauro Laudicella

Abstract

Variation in the provision of health care has long been a policy concern. We adapt the framework for productivity measurement used in the National Accounts, making it applicable for sub‐national comparisons using cross‐sectional data. We assess the productivity of the National Health Service (NHS) across regions of England, termed Strategic Health Authorities (SHAs). Productivity is calculated by comparing the total amount of healthcare output to total inputs for each region, standardised to the national average. Healthcare output comprises 6500 different categories, capturing the number and type of NHS patients treated and the quality of care received. Healthcare inputs include NHS and agency staff, supplies, equipment and capital. We find that productivity varies from 5% above to 6% below the national average. Productivity is highest in South West SHA and lowest in East Midlands, South Central and Yorkshire and The Humber SHAs. We estimate that if all regions were as productive as the most productive region in England, the NHS could treat the same number of patients with £3.2bn fewer resources each year. The methods developed lend themselves to investigate variations in productivity in other types of healthcare organisations and health systems. Copyright © 2012 John Wiley & Sons, Ltd.

Suggested Citation

  • Chris Bojke & Adriana Castelli & Andrew Street & Padraic Ward & Mauro Laudicella, 2013. "Regional Variation In The Productivity Of The English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 22(2), pages 194-211, February.
    • Handle: RePEc:wly:hlthec:v:22:y:2013:i:2:p:194-211
    DOI: 10.1002/hec.2794
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.2794
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.2794?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Street, Andrew & Sivey, Peter & Mason, Anne & Miraldo, Marisa & Siciliani, Luigi, 2010. "Are English treatment centres treating less complex patients?," Health Policy, Elsevier, vol. 94(2), pages 150-157, February.
    2. David M. Cutler & Ernst R. Berndt, 2001. "Introduction to "Medical Care Output and Productivity"," NBER Chapters, in: Medical Care Output and Productivity, pages 1-12, National Bureau of Economic Research, Inc.
    3. Diane Dawson & Hugh Gravelle & Mary O'Mahony & Andrew Street & Martin Weale & Adriana Castelli & Rowena Jacobs & Paul Kind & Pete Loveridge & Stephen Martin & Philip Stevens & Lucy Stokes, 2005. "Developing new approaches to measuring NHS outputs and productivity," Working Papers 006cherp, Centre for Health Economics, University of York, revised Dec 2005.
    4. Alfonso Arpaia & Esther Pérez & Karl Pichelmann, 2009. "Understanding Labour Income Share Dynamics in Europe," European Economy - Economic Papers 2008 - 2015 379, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    5. A. B. Atkinson, 2006. "Editorial: Measurement of Government output and productivity," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 169(4), pages 659-662, October.
    6. Diane Dawson & Hugh Gravelle & Mary O'Mahony & Andrew Street & Martin Weale & Adriana Castelli & Rowena Jacobs & Paul Kind & Pete Loveridge & Stephen Martin & Philip Stevens & Lucy Stokes, 2005. "Developing new approaches to measuring NHS outputs and productivity," Working Papers 006cherp, Centre for Health Economics, University of York, revised Dec 2005.
    7. Adriana Castelli & Mauro Laudicella & Andrew Street, 2008. "Measuring NHS Output Growth," Working Papers 043cherp, Centre for Health Economics, University of York.
    8. Castelli, Adriana & Laudicella, Mauro & Street, Andrew & Ward, Padraic, 2011. "Getting out what we put in: productivity of the English National Health Service," Health Economics, Policy and Law, Cambridge University Press, vol. 6(3), pages 313-335, July.
    9. Adriana Castelli & Diane Dawson & Hugh Gravelle & Rowena Jacobs & Paul Kind & Pete Loveridge & Stephen Martin & Mary O'Mahony & Philip Stevens & Lucy Stokes & Andrew Street & Martin Weale, 2007. "A New Approach To Measuring Health System Output and Productivity," National Institute Economic Review, National Institute of Economic and Social Research, vol. 200(1), pages 105-116, April.
    10. Ernst R. Berndt & David M. Cutler & Richard Frank & Zvi Griliches & Joseph P. Newhouse & Jack E. Triplett, 2001. "Price Indexes for Medical Care Goods and Services -- An Overview of Measurement Issues," NBER Chapters, in: Medical Care Output and Productivity, pages 141-200, National Bureau of Economic Research, Inc.
    11. Adriana Castelli & Diane Dawson & Hugh Gravelle & Andrew Street, 2007. "Improving the measurement of health system output growth," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1091-1107, October.
    12. Reto Schleiniger, 2008. "Regional Quantity, Productivity and Efficiency Measures of the Swiss Health Care System," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 459-476, September.
    13. David M. Cutler & Ernst R. Berndt, 2001. "Medical Care Output and Productivity," NBER Books, National Bureau of Economic Research, Inc, number cutl01-1.
    14. Andrew Street & Padraic Ward, 2009. "NHS input and productivity growth 2003/4 - 2007/8," Working Papers 047cherp, Centre for Health Economics, University of York.
    15. Mary O'Mahony & Lucy Stokes, 2005. "Developing new approaches to measuring NHS outputs and productivity," National Institute of Economic and Social Research (NIESR) Discussion Papers 264, National Institute of Economic and Social Research.
    16. Jack E. Triplett, 2001. "What's Different about Health? Human Repair and Car Repair in National Accounts and in National Health Accounts," NBER Chapters, in: Medical Care Output and Productivity, pages 15-96, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Alexander Karmann & Felix Roesel, 2017. "Hospital Policy and Productivity – Evidence from German States," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1548-1565, December.
    2. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    3. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    4. Adrian Gheorghe & Tracy Roberts & Thomas D. Pinkney & Dion G. Morton & Melanie Calvert, 2015. "Rational Centre Selection for RCTs with a Parallel Economic Evaluation—the Next Step Towards Increased Generalisability?," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 498-504, April.
    5. Salm, Martin & Wübker, Ansgar, 2017. "Causes of regional variation in healthcare utilization in Germany," Ruhr Economic Papers 675, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    6. Adriana Castelli & Martin Chalkley & James Gaughan & Maria Lucia Pace & Idaira Rodriguez Santana, 2019. "Productivity of the English National Health Service: 2016/17 update," Working Papers 163cherp, Centre for Health Economics, University of York.
    7. Zhichao Wang & Valentin Zelenyuk, 2021. "Performance Analysis of Hospitals in Australia and its Peers: A Systematic Review," CEPA Working Papers Series WP012021, School of Economics, University of Queensland, Australia.
    8. Wei Yang & Julien Forder & Olena Nizalova, 2017. "Measuring the productivity of residential long-term care in England: methods for quality adjustment and regional comparison," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(5), pages 635-647, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chris Bojke & Adriana Castelli & Katja Grašič & Andrew Street, 2017. "Productivity Growth in the English National Health Service from 1998/1999 to 2013/2014," Health Economics, John Wiley & Sons, Ltd., vol. 26(5), pages 547-565, May.
    2. Anastasia Arabadzhyan & Adriana Castelli & Martin Chalkley & James Gaughan & Maria Ana Matias, 2022. "Productivity of the English National Health Service: 2019/20 update," Working Papers 185cherp, Centre for Health Economics, University of York.
    3. Adriana Castelli & Martin Chalkley & James Gaughan & Maria Lucia Pace & Idaira Rodriguez Santana, 2019. "Productivity of the English National Health Service: 2016/17 update," Working Papers 163cherp, Centre for Health Economics, University of York.
    4. Anne E. Hall, 2015. "Adjusting the Measurement of the Output of the Medical Sector for Quality: A Review of the Literature," BEA Working Papers 0122, Bureau of Economic Analysis.
    5. Andrew Sharpe & Celeste Bradley & Hans Messinger, 2007. "The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview," CSLS Research Reports 2007-06, Centre for the Study of Living Standards.
    6. Paul Schreyer & Matilde Mas, 2016. "Measuring Health Services in the National Accounts: An International Perspective," NBER Chapters, in: Measuring and Modeling Health Care Costs, pages 25-52, National Bureau of Economic Research, Inc.
    7. Marcella Corsi & Carlo D'Ippoliti, 2013. "The productivity of the public sector: A Classical view," PSL Quarterly Review, Economia civile, vol. 66(267), pages 403-434.
    8. Adriana Castelli & Andrew Street & Rossella Verzulli & Padraic Ward, 2015. "Examining variations in hospital productivity in the English NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 243-254, April.
    9. María José Aragón & Martin Chalkley & Adriana Castelli & James Gaughan, 2016. "Hospital productivity growth in the English NHS 2008/09 to 2013/14," Working Papers 138cherp, Centre for Health Economics, University of York.
    10. María José Aragón Aragón & Adriana Castelli & Martin Chalkley & James Gaughan, 2019. "Can productivity growth measures identify best performing hospitals? Evidence from the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 28(3), pages 364-372, March.
    11. Chris Bojke & Adriana Castelli & Rosalind Goudie & Andrew Street & Padraic Ward, 2012. "Productivity of the English National Health Service 2003-4 to 2009-10," Working Papers 076cherp, Centre for Health Economics, University of York.
    12. Chris Bojke & Adriana Castelli & Katja Grasic & Andrew Street, 2015. "Productivity of the English NHS: 2012/13 update," Working Papers 110cherp, Centre for Health Economics, University of York.
    13. Peter Hart, 2007. "Productivity in the National Health Service," Economics Discussion Papers em-dp2007-45, Department of Economics, University of Reading.
    14. Helen Simpson, 2009. "Productivity In Public Services," Journal of Economic Surveys, Wiley Blackwell, vol. 23(2), pages 250-276, April.
    15. Simon Eckermann & Tim Coelli, 2008. "Including quality attributes in a model of health care efficiency: A net benefit approach," CEPA Working Papers Series WP032008, School of Economics, University of Queensland, Australia.
    16. Andrés Maroto-Sánchez, 2010. "Productivity in the services sector: conventional and current explanations," The Service Industries Journal, Taylor & Francis Journals, vol. 32(5), pages 719-746, October.
    17. Adriana Castelli & Peter C Smith, 2006. "Circulatory Disease in the NHS: Measuring Trends in Hospital Costs and Output," Working Papers 021cherp, Centre for Health Economics, University of York.
    18. Andrew Street & Padraic Ward, 2009. "NHS input and productivity growth 2003/4 - 2007/8," Working Papers 047cherp, Centre for Health Economics, University of York.
    19. Adriana Castelli & Mauro Laudicella & Andrew Street, 2008. "Measuring NHS Output Growth," Working Papers 043cherp, Centre for Health Economics, University of York.
    20. Mara Airoldi & Alec Morton, 2009. "Adjusting life for quality or disability: stylistic difference or substantial dispute?," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1237-1247, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:22:y:2013:i:2:p:194-211. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.