Centre for Health Economics, University of York, York, UK.
Health Econ. 2013 Feb;22(2):194-211. doi: 10.1002/hec.2794. Epub 2012 Feb 14.
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.
医疗保健服务的差异一直是政策关注的焦点。我们采用国民账户中使用的生产力衡量框架，并对其进行调整，使其能够在使用横截面数据进行的次国家级比较中应用。我们评估了英格兰各地区的国民保健服务（NHS）的生产力，这些地区被称为战略卫生当局（SHA）。生产力是通过将每个地区的医疗保健总产出与总投入进行比较来计算的，该产出与全国平均水平标准化。医疗保健产出包括 6500 种不同的类别，涵盖了接受治疗的 NHS 患者的数量和类型以及所接受的护理质量。医疗保健投入包括 NHS 和机构工作人员、用品、设备和资本。我们发现，生产力在全国平均水平上下波动 5%至 6%。生产力最高的是西南 SHA，最低的是东米德兰、中南部和约克郡和亨伯 SHA。我们估计，如果所有地区的生产力都与英格兰生产力最高的地区一样，那么 NHS 每年可以用 32 亿英镑更少的资源治疗相同数量的患者。所开发的方法可用于调查其他类型的医疗机构和卫生系统的生产力差异。
