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Health Policy. 2018 Nov 2. pii: S0168-8510(18)30635-3. doi: 10.1016/j.healthpol.2018.10.016. [Epub ahead of print]

How health policy shapes healthcare sector productivity? Evidence from Italy and UK.

Author information

1
Department of Economics and Finance, University of Rome Tor Vergata, Via Columbia n. 2, 00133, Rome, Italy. Electronic address: atella@uniroma2.it.
2
Department of Economics and Finance, University of Rome Tor Vergata, Via Columbia n. 2, 00133, Rome, Italy. Electronic address: belotti@economia.uniroma2.it.
3
Leeds Institute of Health Sciences (LIHS), 061B, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK. Electronic address: c.bojke@leeds.ac.uk.
4
Centre for Health Economics, University of York, O10 5DD, Heslington York, YO10 5DD, UK. Electronic address: adriana.castelli@york.ac.uk.
5
Centre for Health Economics, University of York, O10 5DD, Heslington York, YO10 5DD, UK. Electronic address: katja.grasic@york.ac.uk.
6
Centre for Economic and International Studies, University of Rome Tor Vergata, Via Columbia n. 2, 00133, Rome, Italy. Electronic address: kopinska@economia.uniroma2.it.
7
Centre for Economic and International Studies, University of Rome Tor Vergata, Via Columbia n. 2, 00133, Rome, Italy. Electronic address: piano.mortari@economia.uniroma2.it.
8
Department of Health Policy, Room 3.03 Cowdray House, London School of Economics and Political Science, London, WC2A 2AE, UK. Electronic address: A.Street@lse.ac.uk.

Abstract

The English (NHS) and the Italian (SSN) healthcare systems share many similar features: basic founding principles, financing, organization, management, and size. Yet the two systems have faced diverging policy objectives since 2000, which may have affected differently healthcare sector productivity in the two countries. In order to understand how different healthcare policies shape the productivity of the systems, we assess, using the same methodology, the productivity growth of the English and Italian healthcare systems over the period from 2004 to 2011. Productivity growth is measured as the rate of change in outputs over the rate of change in inputs. We find that the overall NHS productivity growth index increased by 10% over the whole period, at an average of 1.39% per year, while SSN productivity increased overall by 5%, at an average of 0.73% per year. Our results suggest that different policy objectives are reflected in differential growth rates for the two countries. In England, the NHS focused on increasing activity, reducing waiting times and improving quality. Italy focused more on cost containment and rationalized provision, in the hope that this would reduce unjustified and inappropriate provision of services.

KEYWORDS:

Health policy; Input growth; Output growth; Productivity

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