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Regional variation in the productivity of the English National Health Service

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Publication details

JournalHealth Economics
DateE-pub ahead of print - 14 Feb 2012
DatePublished (current) - 15 Feb 2013
Issue number2
Pages (from-to)194-211
Early online date14/02/12
Original languageEnglish


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.

    Research areas

  • health sector; , productivity; , geographical variation


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