Transcript The Measurement of Output and Productivity in the Health

The Measurement of Output and
Productivity in the Health Care
Sector in Canada: An Overview
Dr. Andrew Sharpe
Executive Director of the Centre for the Study of Living Standards
(CSLS)
Improving Measures of Health Care Output and Outcomes in Canada
Canadian Medical Association (CMA)
Centre for the Study of Living Standards (CSLS)
Ottawa, Ontario
Tuesday, October 30, 2007
1
Motivation for the Conference

With ageing of the population it is expected that the share
of GDP devoted to health care will continue to rise.

Given budget constraints, it is important that the
resources devoted to health care be used in the most
effective manner possible.

To monitor and measure effectiveness, we must be able
to accurately measure health care output and outcomes.

To mobilize players in the health sector to obtain better
measures of health care output and outcomes.
2
Four Reasons Why It Is So Difficult to Measure the Real
Output (and Productivity) of the Health Care Sector

Much of the output of the health care sector is non-marketed
(e.g. hospital care) so there is no measure of nominal output
independent of the value of inputs.

The exact definition of what constitutes the output (as opposed
to activities) of the health care sector is unclear (e.g. number of
procedures performed versus successfully completed
procedures, treatment of chronic conditions).

Medical advances lead to quality improvements in the output of
the health care sector, but it is difficult to adjust the price of
medical services for these improvements. Actual price
increases therefore may overestimate the true cost of qualityadjusted health care.

The potential lack of direct relationship between trends in
health output and productivity and health outcomes due to the
wide range of factors that determine health outcomes (e.g.
lifestyle, environment).
3
Key Issue

Should resources be allocated to initiatives that
approach health output from an industry-based
national accounts perspective and attempt to
develop monetary estimates of the value of the
health care sector that adjust for quality changes,
including health outcome changes?
4
Real and Nominal Health Expenditures in Canada as Shares of Total
Economy GDP, 1984-2006
10.5
10.0
9.5
Per cent
9.0
8.5
8.0
Nominal Health
Expenditures
7.5
7.0
6.5
Real Health
Expenditures (1997
base year)
6.0
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Source: Sources: Canadian Institute for Health Information (2006), "National Health Expenditure Trends", Ottawa, 169 pages; Statistics Canada National Accounts
5
Employment Shares in the Health Care and Social Assistance Industry in
Canada, 2006
Social Assistance
[624]
25%
Nursing and
Residential Care
Facilities [623]
17%
Ambulatory Health
Care Services [621]
23%
Hospitals [622]
35%
Source: Statistics Canada Labour Force Survey
6
Health Care and Social Assistance Employment in the Business and NonBusiness Sectors as a Percentage of Total Health Care and Social
Assistance Employment in Canada, 2005
Business Sector
37.4%
Non-Business
Sector
62.6%
Source: Statistics Canada Table 383-0010
7
Employment in the Health Care and Social Assistance Industry in
Canada, 1987-2006 (average annual growth rates)
4.0
3.71
3.58
3.5
3.0
Per cent
2.5
2.73
2.33
2.0
1.54
1.5
0.83
1.0
0.5
0.0
Heath Care and
Social Assistance
[62]
Ambulatory
Health Care
Services [621]
Hospitals [622]
Nursing and
Social Assistance
Residential Care
[624]
Facilities [623]
Total Economy
Employment
Source: Statistics Canada Labour Force Survey
8
Nominal Output in the Health Care and Social Assistance Industry in
Canada, 1984-2003 (average annual growth rates)
6.65
7
6
5.80
5.27
4.66
Per cent
5
4
3
2
1
0
Health Care and Social
Assistance [62]
Source: Statistics Canada National Accounts
Hospitals [622]
Health Care Services
(excluding hospitals) and
Social Assistance [62A]
Total GDP
9
Deflators for the Health Care and Social Assistance Industry in Canada,
1984-2003
4.5
4.0
3.79
3.95
3.60
3.5
3.0
Per cent
2.34
2.5
2.0
1.5
1.0
0.5
0.0
Health Care and Social
Assistance Industry [62]
Deflator
Hopital Industry [622]
Deflator
Health Care Services
(excluding hospitals) and
Social Assistance Industry
[62A] Deflator
Source: Calculated by the CSLS based on figures from the Statistics Canada National Accounts
GDP deflator
10
Real Output in the Health Care and Social Assistance Industry in Canada,
1984-2003 (average annual growth rates, 1997 dollars)
3.5
2.86
3.0
2.60
Per cent
2.5
2.0
1.93
1.5
1.02
1.0
0.5
0.0
Health Care and Social
Assistance [62]
Hospitals [622]
Health Care Services
(excluding hospitals) and
Social Assistance [62A]
Total GDP
Source: Statistics Canada National Accounts
11
Health Care and Social Assistance Industry Deflator in Canada, 1984-2003
1.4
1.2
Deflator
1.0
0.8
GDP deflator
0.6
0.4
Health Care and
Social Assistance
Industry [62]
Deflator
0.2
0.0
1984 1985
1986 1987 1988
1989 1990 1991
1992 1993 1994 1995
Source: Calculated by the CSLS based on the Statistics Canada National Accounts
1996 1997 1998
1999 2000 2001 2002 2003
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Real and Nominal Output of the Health Care and Social Assistance
Industry in Canada as a Percentage of Total Output, 1984-2003
8.0
7.5
7.0
Per cent
6.5
6.0
5.5
Real Output
5.0
Nominal
Output
4.5
4.0
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Source: Calculated by the CSLS based on the Statistics Canada National Accounts
1996
1997
1998
1999
2000
2001
2002
2003
13
Real GDP per Worker in the Health Care and Social Assistance Industry
in Canada, 1987-2006 (average annual growth rates)
1.5
1.14
1.0
Per cent
0.5
0.28
0.0
-0.5
-1.0
-0.76
-1.5
-1.41
-2.0
Health Care and Social
Assistance [62]
Hospitals [622]
Health Care Services
(excluding hospitals) and
Social Assistance [62A]
Source: Calculated by the CSLS based on the Statistics Canada National Accounts and Labour Force Survey
All Industries
14
Real GDP per Worker in the Health Care and Social Assistance Industry
as a Percentage of the All Industry Average in Canada, 1987-2006
90
80
Health Care and Social
Assistance [62]
70
Per cent
60
50
Hospitals [622]
40
30
20
10
Health Care Services
(excluding hospitals)
and Social Assistance
[62A]
0
87 88 989 990 991 992 993 994 995 996 997 998 999 000 001 002 003 004 005 006
19 19
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
Source: Calculated by the CSLS based on the Statistics Canada National Accounts and Labour Force Survey
15
Official Statistics Canada Productivity Estimates in the Health Care
(excluding hospitals) and Social Assistance Industry in Canada, 1994-2003
(average annual growth rates)
1
0.57
0
-0.28
Per cent
-1
-2
-3
-2.85
-4
-3.83
-5
Based on Gross Output
Based on Value Added
Multifactor Productivity
Source: Statistics Canada CANSIM Table 383-0022
Based on Gross Output
Based on Value Added
Labour Productivity
16
Mortality Rate per 100,000 by Selected Causes in Canada, 1979-2003
160
Colorectal Cancer
Mortality Rate per 100,000
140
120
Lung Cancer
100
80
Acute Myocardial
Infarction (Heart
Attack)
60
40
Cerebrovascular
Diseases
20
20
03
20
01
19
99
19
97
19
95
19
93
19
91
19
89
19
87
19
85
19
83
19
81
19
79
0
Source: Statistics Canada, Vital Statistics, Death Database, and Demography Division (population estimates) CANSIM Tables 102-0026 and
17
102-0126
Health Outcomes in Canada, 1994-2005
35
Percentage of respondents with fair or poor
self-rated health
30
Per cent
25
Percentage of respondents who reported
having moderate or severe health problems
20
Percentage of respondents who reported
staying in bed or cutting down on activities at
least once in the past two weeks
15
10
Percentage of respondents who reported
having a disability or being limited in certain
activities on a continuous basis (at least 6
months) because of a health problem
5
0
1994
1996
1998
2000
2003
2005
Source: CANSIM “Health Indicators” vol. 2007(1). Catalogue no. 82-221-XIE
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Health Outcomes, Health Productivity and Health Output Per Capita in
Canada, 1987-2004
115
Life expectancy at
birth
110
Index, 1987=100
105
100
Real GDP per worker
in the health care and
social assistance
industry
95
90
85
Real GDP of the
health care and social
assistance industry
per capita
80
75
70
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Source: Statistics Canada, Vital Statistics, Death Database, Demography Division Tables 102-0025 and 102-0511; CSLS calculations based
19
on Statistics Canada LFS and National Accounts