Impact of the NHS reforms on english hospital productivity : an analysis of the first three years.
To evaluate the effect of purchaser mix, market competition, and trust status on hospital productivity within the NHS internal market Methods : Hospital cost and activity data were taken from routinely collected data for acute NHS hospitals in England for 1991-2 to 1993-4.
Cross sectional and longitudinal regression methods were used to estimate the effect of trust status, competition, and purchaser mix on average hospital costs per inpatient, after adjusting for outpatient activity levels, casemix, teaching activity, regional salary variation, hospital size, scale of activity, and scope of cases treated.
Real productivity gains were apparent across the study period for NHS hospitals on average.
Casemix adjustment drastically improved cross sectional comparisons between hospitals.
Gaining trust status and increasing host district purchaser share were associated with productivity increases after adjustment for casemix, regional salary differences, and hospital size and scope.
Hospitals that became trusts during the study period were on average less productive at the beginning of the period than those that did not, and there were no significant productivity differences between trust waves at the end of the period in 1993-4.
Market concentration was not associated with productivity differences. (...)
Mots-clés Pascal : Hôpital général, Evaluation, Information marché, Productivité, Rapport coût bénéfice, Etude transversale, Reformage, Achat, Facteur efficacité, Homme, Grande Bretagne, Royaume Uni, Europe, Politique sanitaire, Economie santé
Mots-clés Pascal anglais : General hospital, Evaluation, Market information, Productivity, Cost benefit ratio, Cross sectional study, Reforming, Purchases, Effectiveness factor, Human, Great Britain, United Kingdom, Europe, Health policy, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0549002
Code Inist : 002B30A04D. Création : 24/03/1998.