City Research Online

Regional variation in the productivity of the English national health service

Bojke, C., Castelli, A., Street, A. , Ward, P. & Laudicella, M. (2013). Regional variation in the productivity of the English national health service. Health Economics, 22(2), pp. 194-211. doi: 10.1002/hec.2794


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.

Publication Type: Article
Additional Information: This is the accepted version of the following article: Bojke, C., Castelli, A., Street, A., Ward, P. and Laudicella, M. (2013), REGIONAL VARIATION IN THE PRODUCTIVITY OF THE ENGLISH NATIONAL HEALTH SERVICE. Health Econ., 22: 194–211. , which has been published in final form at
Publisher Keywords: Algorithms, Cross-Sectional Studies, Efficiency, Organizational, England, State Medicine
Subjects: R Medicine > RA Public aspects of medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
PDF - Accepted Version
Download (1MB) | Preview



Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login