Pharaoh and the Prospects for Productivity in HHR

Abstract

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." RésuméLorsque le pharaon refusa de fournir de la paille, la productivité dans l'industrie égyptienne de la brique connut un déclin. Le pharaon avait d' autres préoccupations. Néanmoins, ce sont les Israéliens qui en ont payé les frais, pas les Égyptiens. L' amél-ioration de la productivité dans le secteur de la santé est semblablement contrainte par des objectifs concurrentiels, ainsi que par la distribution des pertes et des gains qui en découlent. De plus, ce n' est que par l' amélioration des résultats pour la santé que les services de santé acquièrent leur pleine valeur. Accroître les extrants pour des services inefficaces n' est d' aucune façon un signe de productivité. Cependant, la t h e

Bringing Knowledge to Action in the Context of a Major Organizational Transition

“…Recently, Evans and colleagues 36 have argued that producing health requires that we not only do the right thing but also do things right! Do the right thing in terms of performance improvement, because doing things wrong means a waste of time or inefficiencies that may result in injury or death.…”

Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned.

“…While VHA continues to progress in the efficient management and monitoring of its mental health productivity, it is important to note that productivity data do not provide information on clinical outcomes for veterans, which is a critical component to be added for assessing mental health care in VHA. Evan and colleagues (2010a, 2010b) have highlighted that in health care, the evaluation of productivity, when it is focused only on activities and processes, has neglected the fundamental relevance and implications of productivity standards as a component of assessing overall quality of care. VHA is currently underway with this effort in its large scale initiative on measurement-based care that will assess patient reported outcomes in clinical care.…”

Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond

“…Real sector-specific GDP per healthcare worker has fallen from 74 per cent of the all-industry average in 1987 to 52 per cent in 2006 (Sharpe et al 2007). While this measure is primarily based on the volume of inputs rather than measuring productivity in terms of the impact of inputs on output, this input measure may be most associated with the "coat-tails effect" noted by Baumol andBowen (1966, 1996) from growth in overall GDP per worker exogenous to the health care system (Evans et al 2010). Even so, controlling for both this measure of input and a measure of health status/quality in an analytical model of health expenditures may combine to produce a rough control for quality-adjusted output even though it is still measured at input-rather than output-prices.…”

“…Sixth, it is assumed that first differencing of the capital-to-labor ratio controls for all vintage effects in capital and depreciation of the capital stock; however, some replacement of older equipment may result in a residual uptick in the rate of increase in this ratio particularly in the area of diagnostic imaging equipment. Finally, and possibly most importantly, this analysis, though it attempted to do so, probably does not control adequately for outcomes and productivity in the health sector given the difficulty of fully measuring such values in the national accounts for a multi-product sector like health (Evans et al 2010). Nevertheless, there may be a need to further investigate this issue at the institutional level or at the level of specific diseases-where technical efficiency is most commonly measured-given that the productivity measures provided in this analysis are all rising during this period of increasing capital-to-labor ratios.…”