Evans Robert G, Barer Morris L, Schneider David G
Healthc Policy. 2010 Feb;5(3):17-26.
When Pharaoh refused to supply straw, productivity plummeted in the Egyptian brick industry. But Pharaoh had other concerns. Anyway, the costs fell on Israelites, not Egyptians. Productivity improvement in the health sector is similarly constrained by competing objectives, and by the distribution of resulting gains and losses. Furthermore, health services have value only insofar as they improve health outcomes. Increased output of ineffective services is not productivity in any meaningful sense. Yet most of the literature on health human resources productivity focuses on outputs, not outcomes, ignoring serious questions about effectiveness. Proposals to refine the treatment of the health sector within the national accounts are similarly flawed. Proliferation of beneficial, harmful or simply unnecessary services would all be recorded as "productivity growth."
当法老拒绝提供草料时，埃及制砖业的生产力大幅下降。但法老还有其他担忧。无论如何，成本落在了以色列人身上，而非埃及人。卫生部门的生产力提升同样受到相互竞争的目标以及由此产生的收益和损失分配的限制。此外，卫生服务只有在改善健康结果的范围内才有价值。无效服务产出的增加在任何有意义的层面上都算不上生产力。然而，大多数关于卫生人力资源生产力的文献都聚焦于产出，而非结果，忽略了有关有效性的严肃问题。在国民账户中完善卫生部门核算的提议同样存在缺陷。有益、有害或仅仅是不必要的服务的增加都会被记录为“生产力增长”。
