1 the measurement of output and productivity in the health care sector in canada: an overview dr....
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1
The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview
Dr. Andrew SharpeExecutive Director of the Centre for the Study of Living Standards
(CSLS)
Improving Measures of Health Care Output and Outcomes in CanadaCanadian Medical Association (CMA)
Centre for the Study of Living Standards (CSLS)Ottawa, Ontario
Tuesday, October 30, 2007
2
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.
3
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 quality-adjusted 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).
4
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?
5
Real and Nominal Health Expenditures in Canada as Shares of Total
Economy GDP, 1984-2006
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
10.5
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Per
cent Nominal Health
Expenditures
Real HealthExpenditures (1997base year)
Source: Sources: Canadian Institute for Health Information (2006), "National Health Expenditure Trends", Ottawa, 169 pages; Statistics Canada National Accounts
6
Employment Shares in the Health Care and Social Assistance Industry in Canada, 2006
Hospitals [622]35%
Nursing and Residential Care Facilities [623]
17%
Social Assistance [624]25%
Ambulatory Health Care Services [621]
23%
Source: Statistics Canada Labour Force Survey
7
Health Care and Social Assistance Employment in the Business and Non-Business Sectors as a Percentage of Total Health Care and Social
Assistance Employment in Canada, 2005
Non-Business Sector62.6%
Business Sector37.4%
Source: Statistics Canada Table 383-0010
8
Employment in the Health Care and Social Assistance Industry in Canada, 1987-2006 (average annual growth rates)
2.33
3.71
0.83
2.73
3.58
1.54
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Heath Care andSocial Assistance
[62]
AmbulatoryHealth Care
Services [621]
Hospitals [622] Nursing andResidential CareFacilities [623]
Social Assistance[624]
Total EconomyEmployment
Per
cen
t
Source: Statistics Canada Labour Force Survey
9
Nominal Output in the Health Care and Social Assistance Industry in Canada, 1984-2003 (average annual growth rates)
5.80
4.66
6.65
5.27
0
1
2
3
4
5
6
7
Health Care and SocialAssistance [62]
Hospitals [622] Health Care Services(excluding hospitals) andSocial Assistance [62A]
Total GDP
Per
cen
t
Source: Statistics Canada National Accounts
10
Deflators for the Health Care and Social Assistance Industry in Canada, 1984-2003
3.793.60
3.95
2.34
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Health Care and SocialAssistance Industry [62]
Deflator
Hopital Industry [622]Deflator
Health Care Services(excluding hospitals) and
Social Assistance Industry[62A] Deflator
GDP deflator
Per
cen
t
Source: Calculated by the CSLS based on figures from the Statistics Canada National Accounts
11
Real Output in the Health Care and Social Assistance Industry in Canada, 1984-2003 (average annual growth rates, 1997 dollars)
1.93
1.02
2.602.86
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Health Care and SocialAssistance [62]
Hospitals [622] Health Care Services(excluding hospitals) andSocial Assistance [62A]
Total GDP
Per
cen
t
Source: Statistics Canada National Accounts
12
Health Care and Social Assistance Industry Deflator in Canada, 1984-2003
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Def
lato
r
GDP deflator
Health Care andSocial AssistanceIndustry [62]Deflator
Source: Calculated by the CSLS based on the Statistics Canada National Accounts
13
Real and Nominal Output of the Health Care and Social Assistance Industry in Canada as a Percentage of Total Output, 1984-2003
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Per
cen
t
Real Output
NominalOutput
Source: Calculated by the CSLS based on the Statistics Canada National Accounts
14
Real GDP per Worker in the Health Care and Social Assistance Industry in Canada, 1987-2006 (average annual growth rates)
-0.76
0.28
-1.41
1.14
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
Health Care and SocialAssistance [62]
Hospitals [622] Health Care Services(excluding hospitals) andSocial Assistance [62A]
All Industries
Per
cen
t
Source: Calculated by the CSLS based on the Statistics Canada National Accounts and Labour Force Survey
15
Real GDP per Worker in the Health Care and Social Assistance Industry as a Percentage of the All Industry Average in Canada, 1987-2006
0
10
20
30
40
50
60
70
80
90
19871988
19891990
19911992
19931994
19951996
19971998
19992000
20012002
20032004
20052006
Per
cen
t
Health Care and SocialAssistance [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
16
Official Statistics Canada Productivity Estimates in the Health Care (excluding hospitals) and Social Assistance Industry in Canada, 1994-
2003 (average annual growth rates)
-2.85
-3.83
0.57
-0.28
-5
-4
-3
-2
-1
0
1
Based on Gross Output Based on Value Added Based on Gross Output Based on Value Added
Multifactor Productivity Labour Productivity
Per
cen
t
Source: Statistics Canada CANSIM Table 383-0022
17
Mortality Rate per 100,000 by Selected Causes in Canada, 1979-2003
0
20
40
60
80
100
120
140
160
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Mor
talit
y R
ate
per
100
,000
Colorectal Cancer
Lung Cancer
Acute MyocardialInfarction (HeartAttack)
CerebrovascularDiseases
Source: Statistics Canada, Vital Statistics, Death Database, and Demography Division (population estimates) CANSIM Tables 102-0026 and 102-0126
18
Health Outcomes in Canada, 1994-2005
0
5
10
15
20
25
30
35
1994 1996 1998 2000 2003 2005
Per
cen
t
Percentage of respondents with fair or poorself-rated health
Percentage of respondents who reportedhaving moderate or severe health problems
Percentage of respondents who reportedstaying in bed or cutting down on activities atleast once in the past two weeks
Percentage of respondents who reportedhaving a disability or being limited in certainactivities on a continuous basis (at least 6months) because of a health problem
Source: CANSIM “Health Indicators” vol. 2007(1). Catalogue no. 82-221-XIE
19
Health Outcomes, Health Productivity and Health Output Per Capita in Canada, 1987-2004
70
75
80
85
90
95
100
105
110
115
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Ind
ex, 1
987=
100
Life expectancy atbirth
Real GDP per workerin the health care andsocial assistanceindustry
Real GDP of thehealth care and socialassistance industryper capita
Source: Statistics Canada, Vital Statistics, Death Database, Demography Division Tables 102-0025 and 102-0511; CSLS calculations based on Statistics Canada LFS and National Accounts