UK Centre for the Measurement of Government Activity Public Service Output, Inputs and Productivity: Healthcare
Maria-Cristina Peñaloza Michael Hardie Richard Wild Katherine Mills
UKCeMGA: Public Service Output, Inputs, and Productivity: Healthcare
1.
Productivity of publicly funded healthcare in the UK
This article presents latest estimates of UK healthcare productivity change using the most recent data and methodological improvements. It updates the series published as part of Total Public Service Output and Productivity (ONS 2009a) and gives the first estimate for 2008. Latest estimates show that: •
from 1995 to 2008 productivity fell by 3.3 per cent, an annual average decline of 0.3 per cent; this is because: - output grew by 69.3 per cent, with an average annual increase of 4.1 per cent - inputs grew by 75.1 per cent, with an average annual increase of 4.4 per cent - productivity fell by 0.7 per cent in 2008, compared with a fall of 0.3 per cent in 2007
However, within this period: • •
productivity fell slightly after 1995 and remained broadly stable until 2001 when it picked up to just under the 1995 level. Average annual productivity growth over this period was 0.0 per cent productivity generally declined by 3.0 per cent from 2001 to 2008 with the exception of a brief pick up in 2005 and 2006. Input growth was generally more rapid than output growth during this period. This was due mainly to increases in the volume of goods and services, particularly in the category that includes goods and services purchased by hospitals, those used in General Practitioner (GP) surgeries and healthcare purchased from outside the NHS
Figure 1.1 Healthcare output, inputs and productivity, 1995—2008 United Kingdom Index numbers, 1995=100 180
170 160 Inputs index
150 Output index
140 130 120 110 Productivity index
100 90 80 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
United Kingdom
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Output index 100.0 101.1 104.1 108.2 111.8 117.3 123.6 130.0 137.1 143.8 151.0 156.4 Inputs index 100.0 102.3 105.1 109.7 112.9 119.0 124.0 133.1 142.6 149.6 157.0 160.1 Productivity index 100.0 98.9 99.1 98.6 99.0 98.6 99.7 97.7 96.2 96.1 96.2 97.7 Source: Office for National Statistics
2006
2007
2008
Index numbers (1995=100) Average annual percentage 2007 2008 change 162.4 169.3 4.1 166.9 175.1 4.4 97.3 96.7 -0.3
1
Figure 1.2 Healthcare output, inputs and productivity, 1995—2008 United Kingdom Annual percentage change
8 Output growth Input growth
6
Productivity growth 4 2 0 -2 -4 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
United Kingdom
1995 1996 1.1 Output growth 2.3 Input growth Productivity growth -1.1 Source: Office for National Statistics
1997 2.9 2.8 0.2
1998 3.9 4.4 -0.5
1999 3.4 2.9 0.5
2000 4.9 5.3 -0.5
2001 5.4 4.2 1.2
2002 5.2 7.4 -2.0
2003 5.5 7.1 -1.6
2004 4.9 4.9 0.0
2005 5.0 4.9 0.1
2006 3.6 2.0 1.6
2007 3.9 4.2 -0.3
2008 4.2 4.9 -0.7
2008
Percentages Average annual percentage change 4.1 4.4 -0.3
Latest estimates incorporate a number of changes since estimates were last published, including: • •
1.1
broader coverage through the inclusion of data for Wales in addition to data for England and Northern Ireland improvements to the methods used to generate estimates of inputs and output
The pattern of productivity change in the UK is dominated by changes in England. The UK pattern reflects: Output • an increase of around 43 per cent in the quantity of Hospital and Community Health Services between 1995 and 2008 •
an increase of just over 200 per cent in the volume of drugs prescribed by GPs between 1995 and 2008. Despite GP-prescribed drugs forming a small share of healthcare output, over the whole period they account for a contribution to output growth similar to that of Hospital and Community Health Services (HCHS), the largest component
•
positive growth in the composite measure of healthcare quality since 2002. The measure takes account of changes in post-operative survival rates, hospital waiting times, outcomes from primary medical care and patient experience
Inputs • an increase of around 40 per cent in the volume of labour used in the provision of publicly funded healthcare between 1995 and 2008 •
a large increase in goods and services consumed in the production of healthcare services, 2
which may reflect increased public resource into healthcare following the publication of the NHS plan in 2000 1 . Some of the increase relates to greater expenditure on non-NHS procurement, which includes contracted-out services and Private Finance Initiatives (PFIs), but the main contribution to growth came from other ‘goods and services’ procured within the NHS. This category includes items ranging from bedding and bandages to electricity and water Output and inputs • an increase in the UK population, within which the proportion of older people has also been increasing. These changes have driven growth in both inputs to and output from publicly funded healthcare, particularly since older people use more health services 1.2
Background
1.2.1
This article continues work to incorporate recommendations of the Atkinson Review: Final Report – Measurement of Government Output and Productivity for the National Accounts (Atkinson 2005).
1.2.2
It presents estimates of multi-factor productivity growth, equal to the growth in the ratio of the volume of output to the volume of inputs. Estimates of output, inputs and productivity are shown on a calendar year basis (for example, 2002). Where pertinent, data used to construct estimates are presented on their original financial year basis (for example, 2002-03).
1.2.3
The estimates are constructed in a similar way to those previously published (ONS 2009a) from 1997 to 2007. However, they are based on the latest health data, covering the period 1995 to 2008 and make use of improvements to the methods used to construct input and output volumes. These changes mean that the latest estimates of inputs, output and productivity differ from those previously published (ONS 2009a) for 1997 to 2007 (see Annex A).
1.2.4
In particular, the productivity estimate for 2007, which in ONS 2009a was based on data for financial year 2006-07, has been revised down. This is because newly available data for 2007-08 show that inputs rose more rapidly than output, reversing the previously published picture. However, in general revisions have increased output and reduced inputs, causing productivity estimates to be revised up in most years.
1.2.5
Key improvements to methods include revisions to the application of deflators used to construct the volume of inputs (see ONS 2010a) and revisions to the cost weights used to construct components of the volume of output following the inclusion of data for Wales.
1.2.6
Most of the methods and data for this article feed into the National Accounts. However, the measure of UK output presented here differs from the National Accounts measure in that it is quality adjusted. The adjustment uses data on health outcomes and patient experience in England to create estimates of quality change.
1.2.7
In the rest of this article: • • • •
section 2 explains how the volume of healthcare output is measured and reports the latest estimates for the UK section 3 explains how the volume of healthcare inputs is measured and reports the latest estimates for the UK section 4 presents a summary of indicators that provide alternative perspectives of changes in publicly funded healthcare, known as triangulation evidence section 5 sets out next steps
1
The NHS Plan: a plan for investment, a plan for reform, available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960 3
2.
Output of Healthcare in the UK
Latest estimates of change in healthcare output show that: •
between 1995 and 2008, healthcare output grew by 69.3 per cent, an average annual increase of 4.1 per cent (figure 2.1) growth was highest from 2000 to 2005, averaging 5.3 per cent a year (figure 2.2) growth was 4.2 per cent in 2008, compared with 3.9 per cent in 2007 (figure 2.2)
• •
Figure 2.1 Healthcare output, 1995—2008 United Kingdom Index numbers, 1995=100 180 170 160 150 140 130 120 110 100 90 80 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
United Kingdom
2006
2007
2008
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Index numbers (1995=100) Average annual percentage change 2007 2008
Output index 100.0 101.1 Source: Office for National Statistics
104.1
108.2
111.8
117.3
123.6
130.0
137.1
143.8
151.0
156.4
162.4
1995
169.3
4.1
Key drivers of output change from 1995 to 2008 include: • • • •
a rapid increase in the volume of drugs prescribed by GPs. Over the whole period, the volume of drugs increased by over 200 per cent, with growth averaging just under 9 per cent per annum. This component accounts for just over one-sixth of output by expenditure weight a rise of around 43 per cent in the quantity of Hospital and Community Health Services (HCHS) over the whole period, or just under 3 per cent a year on average. HCHS is the largest component of output, accounting for around two-thirds of the total by expenditure weight an increase of just under 25 per cent in the quantity of Family Health Services (FHS), with growth averaging 1.7 per cent a year. This is the smallest output component, accounting for a little under onesixth of the total a positive impact from healthcare quality in all years from 2002 onwards, following a slightly negative impact in 2001, when quality adjustment first enters into output estimates
4
Figure 2.2 Healthcare output, 1995—2008 United Kingdom Annual percentage change 6
5
4
3
2
1
0 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
United Kingdom
1995 1996 Output growth 1.1 Source: Office for National Statistics
2.2
1997 2.9
1998 3.9
1999 3.4
2000 4.9
2001 5.4
2002 5.2
2003 5.5
2004 4.9
2005 5.0
2006 3.6
2007 3.9
2007
2008
Percentages Average annual 2008 change 4.2 4.1
Healthcare output has two components: • •
Quantity, which is adjusted for Quality
The following subsections look at each of these components in turn. 2.3
Healthcare quantity
2.3.1
Change in the quantity of UK healthcare is assumed to be the same as the change in a cost weighted activity index covering most types of healthcare activity in England, Northern Ireland and Wales. Measured activities fall into one of three categories: •
Hospital and Community Health Services (HCHS), which include hospital inpatient, day case and outpatient episodes, distinguished by Health Resource Group (HRG)
•
Family Health Services (FHS), which include GP and practice nurse consultations, publicly funded dental treatment and sight tests
•
GP prescribing
5
2.3.2
Figure 2.3 summarises quantity growth for each healthcare component from 1995 to 2008.
Figure 2.3 Quantity measure of healthcare, 1995—2008 United Kingdom Index numbers, 1995=100 320 300 280 GP-prescribed drugs 260 240 220 200 180 Total quantity
160 140 HCHS
120
FHS 100 80 1995 1996 United Kingdom
1997
1998
1999
2000
2001
2002
2003
1995 1996 1997 1998 1999 2000 2001 2002 2003 HCHS 100.0 101.7 104.3 107.9 111.5 114.7 119.6 122.5 126.5 FHS 100.0 97.1 97.7 97.8 97.2 98.8 103.1 105.0 109.3 GP-prescribed drugs 100.0 100.7 109.7 119.5 128.7 147.0 167.0 186.7 205.0 Total quantity 100.0 101.1 104.1 108.2 111.8 117.3 124.4 129.4 135.2 Source: Office for National Statistics
2004
2004 129.8 110.5 224.8 140.5
2005
2005 133.2 114.1 246.2 146.0
2006 135.6 119.4 263.4 150.6
2006
2007
2008
Index numbers (1995=100) Average annual percentage 2007 2008 change 139.8 143.3 2.8 121.6 124.8 1.7 281.4 301.1 8.8 155.9 161.5 3.8
2.3.3
Collectively these categories provide information on around 16,000 types of healthcare activity, accounting for around four-fifths of all spending on healthcare activity in England 2 . The method assumes that the change in unmeasured activity in England, Wales and Northern Ireland and the whole of the change in Scotland is the same as the change in measured activity.
2.3.4
Around 69 per cent of the output index (as of 2007-08) is made up of hospital and community health services (HCHS), while family health services (FHS) and GP-prescribed drugs account for 14 and 17 per cent of output respectively (table 2.4).
Table 2.4 Expenditure-based healthcare weights, 1996-97—2006-07 United Kingdom
Percentages
1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 HCHS 65.3 66.5 65.7 62.9 63.0 66.3 67.5 69.1 66.4 69.3 68.0 68.6 FHS 19.0 17.8 17.4 18.3 17.1 15.4 14.4 12.9 14.0 13.2 14.0 14.1 GP-prescribed drugs 15.7 15.7 16.8 18.9 19.9 18.3 18.1 18.0 19.6 17.5 18.0 17.2 Source: Office for National Statistics
2.3.5
Healthcare quantity grew by 61.5 per cent between 1995 and 2008. GP-prescribed drugs increased most rapidly, averaging 8.8 per cent a year over the whole period and increasing by 7.0 per cent in 2008. HCHS grew most consistently, by an annual average of 2.8 per cent over the whole period, with growth of 2.5 per cent in 2008. FHS declined between 1995 and 2000, but
2
The remainder is accounted for by central expenditure and components that could not be included due to mapping or other measurement issues. See ONS (2009b) for further explanation. 6
growth was positive from 2000 to 2008, bringing annual average growth over the whole period to 1.7 per cent. Overall quantity growth averaged 3.2 per cent a year from 1995 to 2000 but this increased to 4.1 per cent a year from 2000 to 2008. This may reflect increased resources being put into public healthcare following the publication of the NHS plan in 2000. 3 2.3.6
Figure 2.5 shows contributions to growth by component in financial years. Despite HCHS accounting for a much larger proportion of quantity by expenditure share (figure 2.3), the rapid rise in GP-prescribed drugs caused this component to have a similar impact on overall quantity growth over the whole period.
Figure 2.5 Contributions to healthcare quantity growth, 1996-97—2007-08 United Kingdom1,2 Cumulative percentage contribution 60
50
40
30
20
10
0 HCHS
FHS
GP-prescribed drugs
Total weighted growth
1 Northern Ireland data available from 2003-04 onwards 2 FHS data is not available for Wales Source: Office for National Statistics
2.4
Healthcare quality
2.4.1
ONS has used, and continues to use for this article, healthcare output quality adjustments developed by the Centre for Health Economics (CHE) at York University (CHE 2005) and the Department of Health (DH 2005, 2007).
2.4.2
Quality adjustments reflect two dimensions of quality (figure 2.6): (1) The extent to which the service succeeds in delivering intended outcomes (2) The extent to which the service is responsive to users’ needs
3
The NHS Plan: a plan for investment, a plan for reform, available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960 7
Figure 2.6 Components of healthcare quality adjustment
Quality Adjustments
Service Succeeds delivering intended outcomes Short term survival; health gain following treatment in hospital; change in waiting times
Outcomes from primary medical care
•CHD patients’ blood pressure •Stroke patients’ blood pressure •Hypertension patients’ blood pressure •CHD patients’ cholesterol •Stroke patients’ cholesterol
Service is responsive to users needs Hospital inpatients Mental health Primary care
Source: Office for National Statistics
2.4.3
The first dimension which accounts for around 97.5 per cent of total quality change, consists of two measures to adjust the quantity of healthcare output based on success in delivering health gain: i. ii.
short-term survival rates, health gain following treatment in hospital and impact on health gain as a result of change in waiting times for health treatment, and outcomes from primary medical care
2.4.4
Short-term survival rates, health gain following treatment in hospital and the impact of waiting times are measured using Hospital Episode Statistics data. Outcomes from primary medical care are measured using data drawn from the QRESEARCH 4 database.
2.4.5
Quality adjustment based on the extent to which services meet users’ needs or patient experience accounts for around 2.5 per cent of total quality change and is measured using the results of the National Patient Experience Survey Programme. 5
2.5
Impact of quality adjustments on healthcare quantity
2.5.1
The main contribution to quality change came from survival, health gain and waiting times, which improved by an annual average of 0.59 per cent from 2001-02 to 2007-08. Smaller contributions come from primary care and responsiveness to users’ needs, with an annual average improvement of 0.08 per cent and 0.01 per cent respectively over the same period (table 2.7). The overall adjustment for 2008-09 is assumed to be the same as in 2007-08, as source data for that period will not be available until late 2010.
4
For further information see: www.qresearch.org/default.aspx For further information see: www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/NationalsurveyofNHSpatients/index.htm
5
8
Table 2.7 Contributors to quality-adjusted output growth, 2001-02—2008-09 Percentages Outcomes from primary Survival, health gain Total medical care and waiting times 0.00 -0.09 -0.09 0.12 1.25 1.37 0.09 0.64 0.76 0.12 1.06 1.18 0.09 0.72 0.81 0.06 0.28 0.37 0.12 0.29 0.44 0.44 0.08 0.59 0.69 0.66
England
2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 Average 2001-02—2007-08 Average 2001-02—2008-09 Source: Office for National Statistics
2.5.2
Service is responsive to user needs 0.00 0.00 0.02 0.01 0.00 0.03 0.03 0.01
The cumulative impact of quality adjustments is shown in figure 2.8 on a calendar year basis. In 2008, quality-adjusted output was 7.8 index points, or 4.8 per cent, greater than quantity (unadjusted output). From 2001 to 2008, quality adjustments have added an average of 0.6 percentage points a year to output growth.
Figure 2.8 Healthcare quantity and output, 1995—2008 United Kingdom 1995=100 180 Quantity
Output
170 160 150 140 130 120 110 100 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
United Kingdom
Percentages Average annual change 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Quantity 100.0 101.1 104.1 108.2 111.8 117.3 124.4 129.4 135.2 140.5 146.0 150.6 155.9 161.5 3.8 Output 100.0 101.1 104.1 108.2 111.8 117.3 123.6 130.0 137.1 143.8 151.0 156.4 162.4 169.3 4.1 Source: Office for National Statistics
9
3.
Inputs to Healthcare in the UK
Latest estimates of inputs show that: • • • •
between 1995 and 2008, inputs grew by 75.1 per cent, an average annual increase of 4.4 per cent from 2002 to 2005 inclusive, inputs growth was above the average for the whole time period there was positive growth in all years more than half of overall inputs growth was accounted for by increases in the volume of goods and services inputs, despite labour accounting for the largest share of input expenditure
Figure 3.1 Growth in the volume of healthcare inputs, 1995—2008 United Kingdom Index numbers (1995=100) 180 170 160 150 140 130 120 110 100 90 80 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
United Kingdom
Index numbers (1995=100) Average annual percentage 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 change Inputs index 100.0 102.3 105.1 109.7 112.9 119.0 124.0 133.1 142.6 149.6 157.0 160.1 166.9 175.1 4.4 Source: Office for National Statistics
Key changes in inputs between 1995 and 2008 include: •
A 143 per cent of the volume of good and services used in the production of health output, about half of which came from a rise in the volume of ‘other’ goods and services inputs. This category includes a variety of goods and services used in the provision of healthcare in both hospitals and elsewhere. For example, it includes clinical supplies used in hospitals, supplies used in GP surgeries and premises maintenance costs
•
A 41 per cent increase in the volume of labour, which at least partly relates to the recruitment drive following the NHS Plan (DH 2000)
10
Figure 3.2 Growth in the volume of healthcare inputs, 1995—2008 United Kingdom Annual percentage change 8 7 6 5 4 3 2 1 0 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
United Kingdom
1995 1996 1997 Inputs growth 2.3 2.8 Source: Office for National Statistics
1998 4.4
1999 2.9
2000 5.3
2001 4.2
2002 7.4
2003 7.1
2004 4.9
2005 4.9
2006 2.0
2007 4.2
2007
2008
Percentages Average annual change 2008 4.9 4.4
3.1
Components of healthcare inputs at current prices
3.1.1
Healthcare inputs are divided into three broad components: labour (for example medical staff), goods and services (such as clinical supplies and electricity), and capital consumption (a measure of the extent to which the capital stock is used up in a given period).
3.1.2
Expenditure on labour and on goods and services is measured in current prices (what was actually paid). Capital consumption expenditure in current prices is estimated using a model called the Perpetual Inventory Method. Further details can be found in Methods Explained: Perpetual Inventory Method (Dey-Chowdhury 2008).
3.1.3
Table 3.3 summarises changes in expenditure on publicly funded healthcare from 1995 to 2008.
Table 3.3 Expenditure1 on publicly funded healthcare inputs 1995—2008 £ billions Average annual percentage 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 change Labour 23.3 25.2 26.3 27.2 28.1 30.1 33.4 36.5 41.3 46.7 49.6 52.1 54.4 58.1 7.3 Goods and Services 13.5 15.2 15.1 17.0 19.9 20.7 22.3 25.0 26.4 28.5 30.7 35.9 38.5 41.8 9.1 Capital Consumption 1.2 1.3 1.4 1.4 1.4 1.6 1.5 1.6 1.8 1.7 1.8 1.8 1.9 1.8 2.9 Total 38.1 41.7 42.8 45.6 49.4 52.4 57.2 63.1 69.4 76.9 82.1 89.8 94.8 101.7 7.8 ¹Figures are based on General Government Final Consumption Expenditure for healthcare. In the UK National Accounts, all expenditure on GP services is allocated to goods and services. For this article, estimates of expenditure on labour in GP surgeries, and expenditure on capital in GP surgeries have been calculated, subtracted from goods and services expenditure and added to the labour and capital consumption categories. Source: Office for National Statistics
United Kingdom
11
3.1.4
In 2008 expenditure on healthcare inputs was approximately £102 billion. Healthcare is the largest component of General Government Final Consumption Expenditure (GGFCE), accounting for 33 per cent of the total and accounts for around 7 per cent of the expenditure measure of Gross Domestic Product (GDP(E)).
3.1.5
Labour costs make up the largest component of healthcare expenditure. In 2008 current price labour expenditure was £58 billion, 57 per cent of the annual total. In 1995 labour accounted for 61 per cent of total expenditure.
3.1.6
Spending on goods and services accounted for 41 per cent of expenditure in 2008 (£42 billion) in current prices. The component consists of the goods and services procured from the market sector that are consumed in the production of healthcare services in any given year. In 1995 goods and services accounted for 35 per cent of total expenditure.
3.1.7
The smallest inputs component is capital consumption, which represents the annual use of capital assets, rather than to the cost of acquiring them. For 2008 this was estimated at £1.8 billion, or approximately 2 per cent of the total. Goods such as buildings, vehicles and training equipment are medium- to long-term investments that can be used for a number of years, and are hence classified as capital items.
3.2
Measuring the volume of healthcare inputs
3.2.1
The method used to calculate the volume of healthcare inputs has been improved. Details of several methodological improvements were published earlier this year (ONS 2010a); for this article, further improvements were made in terms of coverage and aggregation methods. In comparison to estimates in ONS (2010a), volume growth between 1997 and 2007 has risen from 56.7 to 58.8 per cent.
3.2.2
Healthcare inputs are measured in current price terms and volume terms, with the latter removing the effects of pay and price changes from growth. Input volumes can be measured directly or indirectly. For example, labour inputs can be measured directly using a measure of staff numbers weighted together by expenditure shares or indirectly by deflating current price labour expenditure by an appropriate estimate of changes in pay and other labour costs.
3.2.3
In previously published estimates of healthcare inputs (ONS 2010a), the volume of labour inputs for healthcare was based on staff data for England only. Similarly, the deflator for goods and services was derived using England data. In this article, data for England and Wales are used to estimate the volume of labour inputs, and the deflator for goods and services. It is assumed that the data for England and Wales can be used to represent changes in the whole of the UK.
3.2.4
Healthcare labour inputs are measured directly, as recommended by Measurement of Aggregate and Industry-Level Productivity (Schreyer and Pilat 2001). The calculation method uses a breakdown of full-time equivalent staff numbers weighted together by expenditure share. Further details are given in Public Service Output, Input and Productivity: Healthcare – Extended Analysis (ONS 2010b).
3.2.5
Healthcare goods and services inputs are measured in three parts: GP-prescribed drugs, healthcare purchased from outside the NHS, and other goods and services.
3.2.6
As in Total Public Service Output and Productivity (ONS 2009a), the same measure of the volume of GP-prescribed drugs is used for both inputs and output 6 . The calculation method has been improved, as explained in Health Care Output 1995–2007 (ONS 2009b). The other two parts of goods and services are measured indirectly. More details are found in Public Service Output, Input and Productivity: Healthcare – Extended Analysis (ONS 2010b).
6
Although due to differences in the coverage of output and inputs, GP-prescribed drugs have a higher weight (and therefore a greater impact on growth) in overall output than in overall inputs. 12
3.2.7
Capital consumption estimates for healthcare are consistent with those published in United Kingdom National Accounts: The Blue Book (ONS 2009c).
3.2.8
Table 3.4 summarises changes in the volume of healthcare inputs by component over the period 1995 to 2008. Components are weighted by their relative share of expenditure to calculate the overall index.
Table 3.4 Volume of healthcare inputs by component United Kingdom
1995 1996 Labour 100.0 101.2 Goods and Services 100.0 103.0 Capital Consumption 100.0 114.2 Total inputs index 100.0 102.3 Source: Office for National Statistics
3.2.9
1997 101.7 108.9 126.5 105.1
1998 103.2 119.4 133.3 109.7
1999 105.5 123.6 144.1 112.9
2000 108.0 135.1 158.9 119.0
2001 112.3 142.1 154.0 124.0
2002 118.4 156.8 159.8 133.1
2003 124.4 173.2 164.6 142.6
2004 130.4 182.0 170.8 149.6
2005 134.8 197.2 155.8 157.0
2006 135.5 206.4 149.7 160.1
Index numbers (1995=100) Average annual percentage 2007 2008 change 136.4 141.0 2.7 226.3 243.1 7.1 149.8 147.3 3.0 166.9 175.1 4.4
The volume of UK healthcare inputs grew by 75.1 per cent between 1995 and 2008, an annual average of 4.4 per cent. Between 1995 and 2001, average growth in the volume of total healthcare inputs was lower than the overall average at 3.7 per cent a year. Growth was highest between 2001 and 2003 at an average of 7.2 per cent a year; then grew less quickly between 2003 and 2008 at 4.2 per cent a year on average.
3.2.10 The largest component of growth in the volume of healthcare inputs was goods and services, although labour was also important. Of the 75.1 per cent increase in the total index, goods and services and labour contribute 46.7 and 27.0 percentage points respectively, while capital consumption contributes 1.4 percentage points.
4.
Productivity of healthcare in the UK by component
4.1
Figures 4.1 and 4.2 show the pattern of healthcare productivity between 1995 and 2008 by the main components of healthcare – HCHS, FHS, GP-prescribed drugs – and for total healthcare in the UK. It should be noted that as there is no quality adjustment for GP-prescribed drugs, HCHS and FHS are presented without quality adjustments for comparability. As a result, the productivity index differs from the main productivity index shown in section 1.
4.2
GP-prescribed drugs productivity change should be automatically zero since the same method is used in calculating both output and inputs. However, due to differences in coverage (inclusion of Northern Ireland in the output calculation), and differences in the calculation method between outputs and inputs, the series are slightly different for years 2003 to 2008 (figure 4.1).
4.3
Productivity (with no adjustment for quality change) fell in HCHS by 1.4 per cent a year on average from 1995 to 2008, with growth in inputs of 4.3 per cent a year outstripping growth in the quantity of healthcare of 2.8 per cent a year. From 1995 to 2001, HCHS productivity fell slowly with an average fall of 0.2 per cent a year. From 2001 to 2008, productivity fell on average by 2.4 per cent a year. HCHS growth in inputs is explained by a rapid increase in the volume of labour inputs, in particular between 2000 and 2004, and an accelerated growth in goods and services in inputs.
4.4
There was a fall in the productivity of FHS from 1995 to 2008 of 0.5 per cent a year on average, which can be divided into three distinct periods. From 1995 to 2002 productivity fell 0.5 per cent a year. From 2002 to 2005 productivity decreased at a rapid pace, 2.4 per cent a year on average. However, between 2005 and 2008, FHS productivity increased by 1.3 per cent a year on average.
13
Figure 4.1 Healthcare productivity main components, 1995—2008 United Kingdom Index numbers, 1995=100 115
105 GP-prescribed drugs UK productivity (without quality)
95 FHS HCHS 85
75 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
United Kingdom
1995 1996 HCHS 100.0 99.7 FHS 100.0 95.2 GP-prescribed drugs 100.0 100.0 Uk productivity 100.0 98.9 Source: Office for National Statistics
1997 100.1 95.3 100.0 99.1
1998 99.0 95.0 100.0 98.6
1999 99.8 93.8 100.0 99.0
2000 97.7 95.1 100.0 98.6
2001 98.6 95.3 100.0 100.3
2002 93.4 96.8 100.0 97.2
2003 90.1 95.3 99.0 94.8
2004 88.7 91.0 98.9 93.9
2005 86.8 89.9 98.7 93.0
2006 87.0 92.3 98.7 94.1
2006
2007
2008
Index numbers (1995=100) Average annual percentage 2007 2008 change 85.6 83.3 -1.4 93.5 93.5 -0.5 98.6 99.0 -0.1 93.4 92.2 -0.6
Figure 4.2 Healthcare productivity growth by main components, 1995—2008 United Kingdom Annual percentage change 4
UK productivity
HCHS
FHS
GP prescribed drugs
3 2 1 0 -1 -2 -3 -4 -5 -6
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
United Kingdom
1995 1996 HCHS -0.3 FHS -4.8 0.0 GP prescribed drugs -1.1 UK productivity Source: Office for National Statistics
1997 0.4 0.1 0.0 0.2
1998 -1.1 -0.4 0.0 -0.5
1999 0.8 -1.2 0.0 0.4
2000 -2.1 1.4 0.0 -0.4
2001 1.0 0.2 0.0 1.7
2002 -5.3 1.5 0.0 -3.1
2003 -3.5 -1.5 -1.0 -2.5
2004 -1.6 -4.5 -0.1 -0.9
2005 -2.1 -1.2 -0.2 -1.0
2006 0.2 2.7 0.0 1.2
2007 -1.6 1.2 -0.1 -0.7
2007
2008
Percentages Average annual change 2008 -2.7 -1.4 0.0 -0.5 0.4 -0.1 -1.3 -0.6
14
5.
Triangulation
5.1
The aim of triangulation is to help users understand productivity estimates by providing additional contextual information, giving a wider picture than is possible in a single measure of healthcare productivity.
5.2
A separate paper, Public Service Output, Inputs and Productivity: Healthcare Triangulation (ONS 2010c) looks at a variety of related evidence in more detail. Table 5.1 provides a summary of the key findings.
6.
Next steps
6.1
ONS will continue to work with DH, the NHS Information Centre, health departments in the devolved administrations and others on a number of developments, summarised below.
6.2
Improvements in coverage
6.2.1
The productivity measure in this article includes output and inputs data for England, Northern Ireland and Wales, although coverage for Northern Ireland and Wales is narrower than for England. Future work will look into expanding coverage to include full data for these countries and also for Scotland by working closely with their respective health departments. Work will also focus on increasing the coverage of existing output measures to match more closely the activity covered by expenditure.
6.3
Improvements to the quality adjustments
6.3.1
ONS will continue to work with DH and CHE at the University of York to build upon the existing quality adjustments. In particular, future work will look into replacing some of the assumptions in the survival rate calculation with real data and also into the use of new patient reported outcome measures (PROMs) data collected by DH.
6.4
Improvements to the measure of the volume of inputs
6.4.1
ONS will shortly publish a scoping paper looking into an alternative measurement of primary care input. Since the establishment of the NHS, GPs have been contracted to, rather than being directly employed by, the public sector. The paper will present an alternative approach that considers GP expenditure as part of the intermediate consumption of the NHS, in contrast to the current treatment of GP labour, goods and services and capital consumption alongside directly publicly funded NHS activities. A period of user consultation will follow the paper’s publication.
7.
Acknowledgements
7.1
ONS would like to thank Professor Andy Street and the Centre for Health Economics team at the University of York for their work on healthcare quality adjustments.
15
Table 5.1 Triangulation: Summary of key findings Source of Evidence
Centre for Health Economics (CHE) evidence 2009
Key indicator Productivity, output and inputs growth (breakdown for hospital, community services and GP drugs) Direct or indirect measures of labour inputs, goods and services and capital
Results CHE results indicate positive productivity growth between 2005-06 and 2007-08. ONS results indicate a positive productivity growth in 2004 and 2006, and a negative productivity growth in 2007 and 2008
This research measures crude productivity for: i) dental and medical General results show fall in crude productivity staff; ii) nursing and midwifery; and iii) mainly because increases in staff outstripped health visiting staff. The research does increases in activity not take account of changes in quality of care or outcomes More resources translated into increases No evidence of evaluation of Agenda for Change UK healthcare in staffing: or the new contracts expenditure Hospital admissions per full-time equivalent 41 per cent more consultants increased from consultant increased 6.6 per cent of No information available on its impact in 16 per cent more GPs GDP in 1997 to productivity 8.4 per cent of Number of emergency admissions and elective GDP in 2007 (in 21 per cent more nurses admissions per full-time equivalent nurse increased line with Wanless Review) 27 per cent more allied health No evidence of evaluation professionals Nuffield Trust research results, 2010
Smoking: Decreasing number of deaths attributable to smoking
Promotion of healthier living
Decreasing number of deaths attributable to smoking is partly the result of decreasing smoking prevalence, but it may also have been influenced by changes in healthcare quality (use of anti-inflammatory agents and bronchodilators)
Alcohol consumption: Evidence of increasing pressure on public Increasing number of deaths attributable healthcare services as a result of greater health to alcohol consumption influenced by burden from risk of strokes and heart and increasing prevalence of alcohol vascular diseases as well as cirrhosis and certain consumption among males and females cancers
Positive
Differences in methodology and coverage prevent direct comparisons
Negative
Supportive of overall decline in productivity shown in the article
No evidence Positive No evidence Positive
Inconclusive
Inconclusive
Indication of increase of type-2 diabetes-related amputees, which may give evidence of the quality of diabetes prevention strategies and controlling risk factor in people with diabetes
Negative
UK is doing better than average OECD countries in some indicators
Screening for cervical cancer and breast cancer is higher than average OECD countries, and avoidable hospital admissions for congestive heart failure and hypertension are lower than average OECD
Positive
UK could improve in providing a good quality of healthcare in some others
As compared to average OECD countries, 5-year survival rate for cervical cancer and breast cancer are lower in UK; asthma and diabetes complications admissions are higher in the UK; and in-hospital case-fatality rates are within 30 days of admission for acute myocardial infarction are lower than average OECD countries.
Inconclusive
Average length of stay (ALOS) decreased between 1995-96 and 200708 in England, Northern Ireland and Wales
Reducing length of stay is a major driver of reduced costs and increased productivity in healthcare services
Positive
Elective day case rate increased in Treating patients as day cases instead of as England and Northern Ireland, though at inpatients is expected to reduce required hospital relatively modest rates in the recent past inputs and increase productivity Emergency re-admission rates within 28 days of discharge increased across all age bands between 1998-99 and 200708
Rise in emergency re-admissions may be explained by hospitals dealing with more complex cases, patients with more severe symptoms, or hospitals may be discharging patients too quickly after treatment
Number of operations cancelled at the Many factors could influence changes in the last minute for non-clinical reasons has number of operations cancelled at the last fluctuated since 1996-97, similarly the minute, some of which are outside the control of number of patients not admitted within the NHS. The above makes any linkage between 28 days of cancelled operations had emergency re-admissions and productivity followed a similar pattern complex
Evidence demonstrates increases in inputs, and some increases in output. This evidence is not complete and conclusive to support / oppose main results of this article
No evidence
Nutrition (diet and obesity): Increased prevalence of type-2 diabetes as a result of the rise in obesity
Health at a Glance 2009, OECD 2009
Interpreting changes in productivity
Implied impact on Evidence for productivity productivity article change
Evidence is not complete or conclusive, therefore does not support / oppose main results of this article
This evidence is not complete, therefore does not support / oppose main results of this article
Positive
Inconclusive
Inconclusive
Evidence for ALOS and elective day case is supportive of increased productivity. Remaining evidence is not conclusive. Overall, the results of this section does not support / oppose main results of this article
16
8. References Atkinson A (2005). Atkinson Review: Final Report. Measurement of Government Output and Productivity for the National Accounts, Palgrave Macmillan: Basingstoke, available at: www.statistics.gov.uk/about/data/methodology/specific/PublicSector/atkinson/final_report.asp Centre for Healthcare Economics/National Institute of Economic and Social Research (2005) Developing new approaches to measuring health care output and productivity, York University and National Institute of Economic and Social Research, available at: www.niesr.ac.uk/pubs/searchdetail.php?PublicationID=905 Dawson D, Gravelle H, O’Mahony, Street A, Wale M, Castelli A, Jacobs R, Kind P, Loveridge P, Martin S, Stevens P & Stokes l (2005) Developing New Approaches to Measuring NHS Outputs and Productivity, Final Report, York, Centre for Health Economics Research Paper 6, available at: www.york.ac.uk/inst/che/publications/publicationsbyyear.htm#2005 Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform, available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960 Department of Health (2005) Healthcare output and productivity: Accounting for quality change, December 2005, available at: www.dh.gov.uk/assetRoot/04/12/42/67/04124267.pdf Department of Health (2008). NHS Reference Costs 2006/07, available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082571 Department of Health (2007) Further Developments in Measuring Quality Adjusted Healthcare Output, available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_079021 Department of Health (2008) Emergency readmission rates, further analysis, Finance and Investment Directorate, NHS Medical Directorate, available at:: www.dh.gov.uk/en/Publicationsandstatistics/index.htm Dey-Chowdhury, S. (2008) ‘Methods Explained: Perpetual Inventory Method’, Economic & Labour Market Review, vol 2, no 9, pp 48–2. Eurostat/Commission of the European Communities, International Monetary Fund, Organisation for Economic Co-operation and Development, United Nations and Bank W (1993) System of National Accounts 1993, European Communities/Eurostat, Imf, OECD, United Nations and World Bank. Eurostat (2001) Handbook on price and volume measures in national accounts Office for Official Publications of the European Communities, May 2001, available at: http://epp.eurostat.ec.europa.eu/portal/page?_pageid=1073,46587259&_dad=portal&_schema=PORTAL &p_product_code=KS-41-01-543 ONS (2007b) United Kingdom National Accounts – The Blue Book, from 2000 to 2007, Office for National Statistics, available at: www.statistics.gov.uk/statbase/Product.asp?vlnk=1143&More=N ONS (2008a) Public Service Productivity: Health Care, Office for National Statistics, January 2008, available at: www.statistics.gov.uk/cci/article.asp?ID=1922 NS (2008b) Sources and Methods for Public Service Productivity, January 2008, available at: www.statistics.gov.uk/articles/nojournal/SMH32008finalversion.pdf ONS (2009a) Total Public Service Output and Productivity, June 2009, available at: www.statistics.gov.uk/cci/article.asp?ID=2212
17
ONS (2009b) Health Care Output 1995–2007, June 2009, available at: www.statistics.gov.uk/cci/article.asp?id=2213 ONS (2009c) United Kingdom National Accounts – The Blue Book 2008, available at: www.statistics.gov.uk/statbase/Product.asp?vlnk=1143 ONS (2010a) Improving the method used to calculate the volume of healthcare inputs, February 2010, available at: www.statistics.gov.uk/cci/article.asp?ID=2354 ONS (2010b) Public Service Output, Inputs and Productivity: Healthcare – Extended Analysis, UKCeMGA, Office for National Statistics, available at: www.statistics.gov.uk/CCI/article.asp?ID=2383 ONS (2010c) Public Service Output, Inputs and Productivity: Healthcare Triangulation, UKCeMGA, Office for National Statistics, available at: www.statistics.gov.uk/CCI/article.asp?ID=2384 Schreyer P and Pilat D (2001). Measuring Productivity: Measurement of Aggregate and Industry-Level Productivity Growth (OECD), 2009. available at: www.oecd.org/dataoecd/59/29/2352458.pdf Street, Andrew & Ward, Padraic (2009) NHS Input and Productivity Growth, CHE Research Paper 47, The University of York and the Centre for Health Economics, April 2009 Wanless (2002) Securing Our Future Health: Taking a Long-Term View: Final Report, Derek Wanless, available at: www.hm-treasury.gov.uk/Consultations_and_Legislation/wanless/consult_wanless_final.cfm Wanless Report (2004) Securing Good Health for the Whole Population, Final Report, Derek Wanless, February 2004 Wanless D, Appleby J, Harrison A and Patel D (2007) Our Future Health Secured? A Review of NHS Funding and Performance, King’s Fund
18
Annex A:
Revisions to Published Estimates
A.1
This annex reports revisions to ONS estimates of the growth in healthcare output, inputs and productivity since estimates were last published.
A.2
Revisions to published data may arise when: • • •
part-year forecasts of financial year administrative data that feed into the latest calendar year estimates are replaced by actual data historical administrative data is revised by providers improvements are made to the estimation methodology (for example, as presented in ONS 2010a)
A.3
Estimates of inputs, output and productivity were published in Total Public Service Output and Productivity (ONS 2009a), covering the period 1997 to 2007. Following that article, revised inputs estimates were published in Improving the method used to calculate the volume of healthcare inputs (ONS 2010a), again covering 1997 to 2007.
A.4
Accordingly, this section presents revisions to inputs since ONS (2009a) and ONS (2010a) and revisions to outputs and productivity since ONS (2009a).
A.5
Current estimates cover the period 1995 to 2008. Comparisons between the three articles are presented over the longest overlapping period, 1997 to 2007, with current estimates rebased to 1997.
A.6
Tables A.1 and A.2 summarise the output, input and productivity indices presented in this article. Table A.2 rebases the index to make it comparable to indices in ONS (2009a) and ONS (2010a).
Table A.1 Estimates of healthcare output, inputs and productivity as presented in this article 1995—2008 United Kingdom
1995 1996 Output index 100.0 101.1 Input index 100.0 102.3 100.0 98.9 Productivity Source: Office for National Statistics
1997 104.1 105.1 99.1
1998 108.2 109.7 98.6
1999 111.8 112.9 99.0
2000 117.3 119.0 98.6
2001 123.6 124.0 99.7
2002 130.0 133.1 97.7
2003 137.1 142.6 96.2
2004 143.8 149.6 96.1
2005 151.0 157.0 96.2
2006 156.4 160.1 97.7
Index numbers (1995=100) Average annual change 2007 2008 (per cent) 4.1 162.4 169.3 4.4 166.9 175.1 -0.3 97.3 96.7
Table A.2 Estimates of healthcare output, inputs and productivity 1995—2008, rebased to 1997 United Kingdom
1995 1996 Output index 96.1 97.1 Input index 95.2 97.3 Productivity index 101.0 99.8 Source: Office for National Statistics
1997 100.0 100.0 100.0
1998 103.9 104.4 99.5
1999 107.4 107.5 100.0
2000 112.7 113.2 99.5
2001 118.8 118.0 100.6
2002 124.9 126.7 98.6
2003 131.7 135.7 97.1
2004 138.2 142.4 97.1
2005 145.1 149.4 97.1
2006 150.2 152.3 98.6
2007 156.1 158.8 98.3
Index numbers (1997=100) Average Average annual annual percentage percentage change change 1995 to 1997 to 2008 2007 2008 162.7 4.1 4.6 166.6 4.4 4.7 97.6 -0.3 -0.2
19
A.7
Table A.3 summarise inputs indices as presented in ONS 2009a, ONS 2010a and this article. Table A.4 summarise inputs growth rates and growth differences between this article and ONS 2009a, and ONS 2010a.
Table A.3 Estimates of healthcare inputs as previously published in ONS 2009a, ONS 2010a and this article, 1997-2007 United Kingdom
1997 100.0 Inputs ONS 2009a Inputs ONS 2010a 100.0 Inputs this article 100.0 Source: Office for National Statistics
1998 104.8 104.4 104.4
1999 108.0 107.5 107.5
2000 114.1 113.2 113.2
2001 119.0 118.1 118.0
2002 128.0 126.8 126.7
2003 137.5 135.9 135.7
2004 144.2 142.5 142.4
2005 152.3 150.1 149.4
Index numbers (1997=100) Average annual percentage change 2006 2007 156.2 159.3 4.8 153.8 156.7 4.6 152.3 158.8 4.7
Table A.4 Healthcare inputs growth and differences between ONS 2009a, ONS 2010a and this article, 19982007 United Kingdom Inputs growth ONS 2009a Inputs growth ONS 2010a Inputs growth this article Diffs ONS 2009a to ONS 2010a Diffs ONS 2010a to this article Total difference Source: Office for National Statistics
1998 4.8 4.4 4.4 -0.5 0.1 -0.4
1999 3.1 3.0 2.9 -0.1 -0.1 -0.1
2000 5.6 5.3 5.3 -0.3 0.0 -0.3
2001 4.3 4.3 4.2 0.0 -0.1 -0.1
2002 7.5 7.4 7.4 -0.2 0.0 -0.2
2003 7.4 7.1 7.1 -0.2 0.0 -0.3
2004 4.9 4.9 4.9 0.0 0.0 0.0
2005 5.6 5.4 4.9 -0.2 -0.4 -0.7
2006 2.6 2.5 2.0 -0.1 -0.5 -0.6
Percentages Mean 2007 2.0 1.9 4.2 -0.1 -0.2 2.4 0.1 2.3 0.0
A.8.
Administrative data used to form input estimates generally become available for processing around 18 months after the period which they cover. In this article inputs figures for 2007 previously estimated in ONS 2010a using data for financial year 2006-07 are based wholly on reported data for 2006-07 and 2007-08. The above explained the relatively large difference of 2.4 percentage points in 2007 between this article and ONS 2010a, where two of the goods and services series – other goods and services inputs and purchases from non-NHS bodies – grew much more rapidly than had previously been estimated.
A.9
Table A.5 summarises the output indices as presented in ONS 2009a, and this article. Table A.6 summarises output growth rates, and growth differences between this article and ONS 2009a.
Table A.5 Estimates of healthcare output as previously published in ONS 2009a and this article, 1997-2007 United Kingdom
1997 100.0 Output ONS 2009a Output this article 100.0 Source: Office for National Statistics
1998 103.8 103.9
1999 107.0 107.4
2000 111.7 112.7
2001 118.0 118.8
2002 123.7 124.9
2003 130.2 131.7
2004 136.3 138.2
2005 143.0 145.1
Index numbers (1997=100) Average annual percentage change 2006 2007 147.7 152.5 4.3 150.2 156.1 4.6
20
Table A.6 Healthcare output growth and differences between ONS 2009a and this article, 1998-2007 United Kingdom Output growth ONS 2009a Output growth this article Diffs ONS 2009a to this article Source: Office for National Statistics
1998 3.8 3.9 0.2
1999 3.1 3.4 0.3
2000 4.4 4.9 0.4
2001 5.6 5.4 -0.2
2002 4.8 5.2 0.3
2003 5.3 5.5 0.2
2004 4.7 4.9 0.2
2005 4.9 5.0 0.1
2006 3.3 3.6 0.2
Percentages 2007 Mean 3.2 3.9 0.7 0.2
A.10
As for inputs, much of the administrative data used for outputs is not available until around 18 months after the period which it covers. In this article output figures for 2007 that were estimated in ONS 2009a using part year forecasts of data for financial year 2006-07 are based wholly on reported data for 2006-07 and 2007-08. This underlies the revision between ONS 2009a and this article of 0.7 percentage points in 2007.
A.11
Table A.7 summarises the productivity indices as presented in ONS 2009a and this article. Table A.8 summarises productivity growth rates, and growth differences between this article and ONS 2009a.
Table A.7 Estimates of healthcare productivity as previously published in ONS 2009a and this article, 19972007 United Kingdom
1997 Productivity ONS 2009a 100.0 100.0 Productivity this article Source: Office for National Statistics
1998 99.0 99.5
1999 99.0 100.0
2000 97.9 99.5
2001 99.1 100.6
2002 96.6 98.6
2003 94.7 97.1
2004 94.5 97.1
2005 93.9 97.1
Index numbers (1997=100) Average annual percentage change 2006 2007 94.6 95.7 -0.4 98.6 98.3 -0.2
Table A.8 Healthcare productivity growth and differences between ONS 2009a and this article, 1998-2007 United Kingdom Productivity growth ONS 2009a Productivity growth this article Diffs ONS 2009a to this article Source: Office for National Statistics
1998 -1.0 -0.5 0.5
1999 0.0 0.5 0.4
2000 -1.1 -0.5 0.7
2001 1.3 1.2 -0.1
2002 -2.5 -2.0 0.5
2003 -2.0 -1.6 0.4
2004 -0.2 0.0 0.2
2005 -0.7 0.1 0.7
2006 0.7 1.6 0.8
Percentages 2007 Mean 1.2 -0.3 -1.5 0.3
A.12
Figure A.1 illustrates the final revisions to growth in output, inputs and productivity between publications ONS 2009a, ONS 2010a, and this article.
A.13
Over the period 1997 to 2007, the mean revision to output growth is 0.2 percentage points, while the mean revision to inputs growth is nil (figure A.1). The net result is an upward mean revision to productivity growth of 0.3 percentage points.
A.14
In summary, the impact of revisions to data and methods since estimates were last published is as follows:
21
• • •
output growth has been revised upwards fairly evenly in most years but by a larger amount in 2007 inputs growth has been revised downwards in most years, but upwards by a large amount in 2007 productivity change has been revised upwards in most years but downwards in 2007, such that change has now become negative in that year
Figure A.1 Revisions to growth estimates for healthcare output, inputs and productivity, 1998-2007 United Kingdom 3.0 Output
Inputs
Productivity
2.0
1.0
0.0
-1.0
-2.0 1998
1999
2000
2001
2002
2003
2004
2005
2006
United Kingdom Output Inputs Productivity Source: Office for National Statistics
1998 0.2 -0.4 0.5
1999 0.3 -0.1 0.4
2000 0.4 -0.3 0.7
2001 -0.2 -0.1 -0.1
2002 0.3 -0.2 0.5
2003 0.2 -0.3 0.4
2004 0.2 0.0 0.2
2005 0.1 -0.7 0.7
2006 0.2 -0.6 0.8
2007 Percentage points 2007 Mean 0.7 0.2 2.3 0.0 -1.5 0.3
22
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