Over the last 50 years there has been a regular cycle of Government committees which have forecast “shortages” and “surpluses” in medical manpower. It is remarkable how little change there has been in the methods used in these forecasts. This has occurred despite regular critiques of the...

This Discussion Paper argues that the government has been right both in its rejection of market solutions to health insurance and in its injection of competition into provider markets. The particular advantages of the latter are that the collective expression of demand is maintained, with...

The current debate about reforming the NHS is surprising in a number of ways. Timmins (1988) points out that it was unforeseen and not part of the Government’s main concerns after winning the election in June 1987. It is surprising in another way because it is only six years ago since there...

Increased efficiency is one of the major objectives of the reforms of the NHS. However, this begs the question of how efficiency will be assessed, since one cannot necessarily assume that the adoption of market principles will automatically lead to efficiency. This paper discusses the methods...

There has been increasing interest in the ability of different methods to rank efficient hospitals over their inefficient counterparts. The UK Department of Health has used three cost indices to benchmark NHS Trusts. This study uses the same dataset and compares the efficiency rankings from the...

This paper reports work undertaken for the Department of Health to explore different approaches of measuring hospital efficiency. The emphasis throughout is on developing adjusted cost-efficiency measures in line with NHS Trusts performance objectives. Previous work described the derivation of...

Accounting for variation in the quality of care is a major challenge for the assessment of hospital cost performance. Because data on patients’ health improvement are generally not available, existing studies have resorted to inherently incomplete outcome measures such as mortality or...

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial we describe the technical details of how to conduct DCEA, using an illustrative example comparing...

This paper reports the results of an investigation into the technical efficiency (i.e. the ability to convert inputs into outputs) the NHS hospital sector. The method employed is the ‘stochastic frontier production function’. In contrast to the approach adopted by Feldstein in his...