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Efficiency & productivity

Efficiency & productivity

The NHS is required to meet increasing health care demands from a growing, aging and sicker population with historically low actual and planned increases in resources.  The scale of this issue is such that the NHS is required to deliver unprecedented efficiency gains estimated to be in the region of ten-fold the historical average. Improved productivity and efficiency have therefore become key policy objectives at this critical time in the NHS’s history – most recently demonstrated by the newly created role of ‘NHS productivity’ minister in the new Government. Our work in this area spans over a decade’s worth of research and has attracted European and further international attention.

Our work on productivity includes:

  • methodological developments in the measurement and construction of output and input indices
  • annual updates of indices of output, input and productivity growth for the National Health Service, for England as a whole and by healthcare setting
  • estimates of productivity at regional level
  • analysis of hospital productivity

Contact: Adriana Castelli

Publications

2019

  • Aragon MJ, Castelli A, Chalkley MJ, Gaughan JM. Can productivity growth measures identify best performing hospitals? Evidence from the English NHS. Health Economics 2019;28(3):364-372. Download from Wiley 
  • Atella V, Belotti F, Bojke C, Castelli A, Grašič K, et al. How health policy shapes healthcare sector productivity? Evidence from Italy and UK. Health Policy 2019;123(1):27-36. Download from ScienceDirect 
  • Castelli A, Chalkley M, Gaughan J, Pace M-L, Rodriguez Santana I. Productivity of the English National Health Service: 2016/17 update. Centre for Health Economics, University of York;CHE Research Paper 163 (PDF , 3,742kb)‌ 2019.
  • Gaughan JKasteridis PMason A, Street A. Why are there long waits at English emergency departments? European Journal of Health Economics2019;doi:10.1007/s10198-019-01121-7. Download from Springer

2018

  • Bojke C, Castelli A, Grašič K, Mason A, Street A. Accounting for the quality of NHS output. Centre for Health Economics, University of York;CHE Research Paper 153 (PDF, 2,261kb) 2018. 
  • Castelli A, Chalkley M, Rodriguez Santana I. Productivity of the English National Health Service: 2015/16 update. Centre for Health Economics, University of York;CHE Research Paper 152 (PDF, 3,099kb) 2018.

2017

  • Aragon MJCastelli AGaughan J. Hospital Trusts productivity in the English NHS: uncovering possible drivers of productivity variations. PloS One 2017;12(8):e0182253. Download from plosone
  • Bojke C, Castelli A, Grašič KHowdon D, Rodriguez Santana I, Street ACentre for Health Economics, University of York; CHE Research Paper 146 (PDF , 3,322kb) 2017.
  • Bojke C, Castelli AGrasic KStreet AD. Productivity growth in the English National Health Service from 1998/1999 to 2013/2014. Health Economics 2017;26(5):547-565.
  • Chalkley MJ, McCormick B, Anderson R, Aragon MJ, Nessa N, Nicodemo C, Redding S, Wittnberg R. Elective hospital admissions: secondary data analysis and modelling with an emphasis on policies to moderate growth. Health Services and Delivery Research 2017;5(7). Download from NIHR

2016

  • Aragón MJCastelli AChalkley MGaughan J. Hospital productivity growth in the English NHS 2008/09 to 2013/14. Centre for Health Economics, University of York;CHE Research Paper 138 (PDF , 2,652kb)‌ 2016.
  • Bojke C, Castelli AGrašič K, Howdon D, Street A. Productivity of the English NHS: 2013/14 Update. Centre for Health Economics, University of York; CHE Research Paper 126 (PDF , 3,087kb)‌ 2016.
  • Bojke CCastelli AGrasic KHowdon DStreet A. Did NHS productivity increase under the Coalition government? In Exworthy M, Mannion R, Powell M. (eds) Dismantling the NHS: Evaluating the Impact of Health Reforms. Bristol (UK);Policy Press 2016:p65-86.
  • Obure CD, Jacobs R, Guinness L, Mayhew S, Vassall A. Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures. Social Science & Medicine 2016;151:147-156. Download from ScienceDirect
  • Puig-Peiro R, Mason A, Mestre-Ferrandiz J, Towse A, McGrath C, Jonsson B. Relative effectiveness in breast cancer treatment: A health production approach. International Journal of Health Technology Assessment 2016;31(6):371-379.
  • Towse A, Jonsson B, McGrath C, Mason A, Puig-Peiro R, Mestre-Ferrandiz J, Pistollato M, Devlin N. Understanding variations in relative effectiveness: A health production approach. International Journal of Health Technology Assessment 2016;31(6):363-370.

2015

  • Aragon MJACastelli A, Gaughan J. Hospital trusts productivity in the English NHS: uncovering possible drivers of productivity variations. Centre for Health Economics, University of York; CHE Research Paper 117 (PDF , 1,991kb)‌ 2015.
  • Bojke C, Castelli A, Grasic K, Street A. Productivity of the English NHS: 2012/13/update. Centre for Health Economics, University of York; CHE Research Paper 110 (PDF  , 2,412kb) 2015.
  • Castelli A, Street A, Verzulli R, Ward P. Examining variations in hospital productivity in the English NHS. European Journal of Health Economics 2015;16(3):243-254.
  • Castelli A, Daidone S, Jacobs RKasteridis PStreet A. The determinants of costs and length of stay for hip fracture patients. PLoS One 2015;doi:10.1371/journal.pone.0133545. Download from PlosONE
  • Gutacker N, Harris A, Brennan D, Hollingsworth B. The determinants of dentists’ productivity and the measurement of output. Social Science & Medicine 2015;124:76-84.
  • Street ANot as it seems: Productivity growth isn't always a good thingHealth Service Journal 9 April 2015.

2014

  • Bojke C, Castelli A, Grasic K, Street A. Productivity of the English National Health Service from 2004/5: updated to 2011/12. Centre for Health Economics, University of York; CHE Research Paper 94 (PDF , 969kb) 2014. Accompanying spreadsheet covering NHS productivity from 1998/9 to 2011/12 National Productivity (94) (MS Excel , 1,704kb) 
  • Street A. Living through the NHS’s famine years. BMJ 2014;349:g6536. Download from BMJ
  • Street A, Castelli A. Eliminating poor productivity is key to NHS improvement. Health Service Journal 13 March 2014.
  • Street A. Don’t believe the hype, productivity is rising. Health Service Journal 17 January 2014.

2013

  • Bojke C, Castelli A, Grasic K, Street A, Ward P. NHS productivity from 2004/5 to 2010/11. Centre for Health Economics, University of York;CHE Research Paper 87 (PDF , 3,728kb) 2013. Accompanying spreadsheet National Productivity (MS Excel , 601kb) and Press Release 87 (PDF , 32kb)
  • Bojke C, Castelli A, Laudicella M, Street A, Ward P. Regional variation in the productivity of the English National Health Service. Health Economics 2013;22(2):194-211.
  • Olsen KR, Gyrd-Hansen D, Højmark TB, Kristensen T, Vedsted P, Street A. Organisational determinants of production and efficiency in General Practice. A population based study. European Journal of Health Economics 2013:14(2):267-276. Download from Springer

2012

  • Bojke C, Castelli A, Goudie R, Street A, Ward P. Productivity of the English National Health Service 2003-4 to 2009-10. Centre for Health Economics, University of York; CHE Research Paper 76 (PDF , 847kb) 2012.

2011

  • Castelli A, Laudicella M, Street A, Ward P. Getting out what we put in: productivity of the English NHS. Health Economics, Policy and Law 2011;6:313-335. Download from Cambridge Journals ©Cambridge Journals.

2010

  • Bojke C, Castelli A, Laudicella M, Street A, Ward P. Regional variation in the productivity of the English National Health Service. Centre for Health Economics, University of York; CHE Research Paper 57 (PDF , 581kb)‌ 2010.