Söderlund N
Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.
J Health Serv Res Policy. 1999 Jan;4(1):6-15; discussion 23-6. doi: 10.1177/135581969900400104.
Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear to have been made in this area in the last year or so. Few systematic evaluations have been undertaken of the value of general management input, however, and policy changes appear to have been largely determined by popular opinion. This study attempts to quantify the effect of management input on hospital productivity for the first three years of the NHS internal market (1991/2-1993/4).
An average cost function was used to model the effect of management inputs on hospital costs after adjustment for the levels of outputs produced, input costs, and internal and external exogenous constraints on hospital functioning. Two measures of management input were used: the proportion of total spending consumed by top level management, and the proportion consumed by all administrative activities. Cross-sectional and longitudinal models with contemporaneous and lagged management input effects were estimated.
Higher spending on top level management was associated with poorer productivity levels in most instances. Total administrative inputs had a weaker, but still generally negative, association with productivity.
No evidence was found that increasing management inputs was associated with improved productivity. On the contrary, spending more on top level managers appeared in fact to be associated with lower productivity levels. Results would thus appear to be in line with decisions to reduce the level of expenditure on management in NHS hospitals. Quality differences could not be measured, however, and it is possible that management input is associated with quality improvements which might reduce or reverse observed productivity losses.
在过去四年左右的时间里，英国国民医疗服务体系（NHS）的管理员工水平受到了相当多的政治和媒体关注。上届政府和本届政府都致力于削减医疗服务中的管理开支，在过去一年左右的时间里，这一领域似乎已经进行了大幅削减。然而，很少有对一般管理投入价值的系统评估，政策变化似乎在很大程度上由公众舆论决定。本研究试图量化国民医疗服务体系内部市场头三年（1991/2 - 1993/4）管理投入对医院生产率的影响。
使用平均成本函数来模拟管理投入对医院成本的影响，同时对产出水平、投入成本以及医院运营的内部和外部外部约束进行调整。使用了两种管理投入的衡量指标：高层管理消耗的总支出比例，以及所有行政活动消耗的比例。估计了具有同期和滞后管理投入效应的横断面模型和纵向模型。
在大多数情况下，高层管理支出增加与生产率水平较低相关。总行政投入与生产率的关联较弱，但总体上仍为负相关。
没有证据表明增加管理投入与提高生产率相关。相反，事实上，在高层管理人员上花费更多似乎与较低的生产率水平相关。因此，结果似乎与削减国民医疗服务体系医院管理支出水平的决定一致。然而，无法衡量质量差异，并且管理投入可能与质量改进相关，这可能会减少或扭转观察到的生产率损失。
