Centre for Health Economics, University of York, Heslington, York, UK.
Health Econ Policy Law. 2011 Jul;6(3):313-35. doi: 10.1017/S1744133110000307. Epub 2010 Oct 28.
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.
许多国家正在国民账户中纳入对非市场产出的直接衡量。要将任何特定产出纳入其中，就必须有关于该产出在两个相邻时期的数据。这是有问题的，因为非市场产出的分类往往会进行全面修订。我们概述了与分类变化相关的挑战，并提出了一个解决方案。为了说明这一点，我们构建了产出和投入指数，并估计了 2003-2004 年至 2007-2008 年期间英国国家卫生服务体系（NHS）的生产力增长。我们的产出增长指数包含了向 NHS 患者提供的所有护理，并捕捉了生存率、等待时间和疾病管理方面的改善。我们发现，接受治疗的患者人数有所增加，他们所接受的护理质量也在提高。我们实施了我们的方法来处理卫生服务定义的变化，并展示了这对产出增长估计的影响。我们的投入增长指数包含了卫生服务生产中所有劳动力、中间投入和资本投入，并且改进了过去对资本的衡量方式。投入随着时间的推移而增加，但自 2005-2006 年以来增长有所放缓，这主要是由于员工招聘趋于平稳以及对代理员工的依赖减少所致。通过比较产出增长与投入增长来评估生产力，其净效应是 2003-2004 年至 2007-2008 年期间生产力的恒定增长。
