PRODUCTIVITY GROWTH IN HEALTH-CARE-DELIVERY

OBJECTIVES. The authors compute and compare productivity growth in the health-care sectors for a sample of Organization for Economic Coopera tion and Development countries over the period from 1974 to 1989. The authors compute Malmquist productivity indexes, which allow productivi ty growth to be decomposed into efficiency changes and technical chang e. These indexes also allow the use of primary quantity data (recently available from the Organization for Economic Cooperation and Developm ent), rather than expenditure data, which the authors argue reduces bi as resulting from distorted prices. METHODS. The authors specify two m odels. The first model focuses on the hospital sector; inputs include physicians and medical care beds, whereas outputs are the ''intermedia te'' type used in hospital efficiency studies, namely, inpatient days and discharges. RESULTS. For the 19 countries with complete data, the authors found little productivity growth based on this model (with the exception of Denmark, with 15.4% cumulated growth, and the United Sta tes, with about 5% from 1974 to 1989). The authors did find, however, that the highest productivity levels are found in the United States (I taly and Finland were also on the frontier of technology in the base p eriod, 1974). The second model uses the same inputs as the first (but in per capita terms), but it specifies simple proxies of health outcom es as outputs: life expectancy of women at age 40 and the reciprocal o f the infant mortality rate. CONCLUSIONS. For the 10 countries with co mplete data for this model, the authors found evidence of much more wi despread and rapid productivity growth: Denmark's cumulated growth was close to 33%, with the United States close behind. In both these coun tries, this growth was due solely to technical change over this period .