The%20Dutch%20experience%20in%20measuring%20health%20output%20and%20labour%20productivity

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The Dutch experience in measuring health output
and labour productivity

• Antonio Chessa
• Foske Kleima
• Statistics Netherlands (CBS)

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Outline

• Output index for hospitals
• Other health sectors (data)
• Labour productivity of general hospitals

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Health output hospitals

• Clinical and day treatments
• Outpatient services
• Other services
• Psychiatric treatments
• Rehabilitation
• Outpatient births
• Haemodialysis
• Thrombosis services

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Clinical and day treatments Data

• Hospital Discharge Register (Dutch LMR)
• For every patient
• Date of birth
• Diagnosis (ICD-codes)
• Hospitalisation days
• Clinical ( 24 hrs) or day treatment (lt 24 hrs)

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Clinical and day treatments Index

• Diagnosis Age-groups
• Diagnosis 3-digit ICD
• Age 7 classes
• Volume indices
• Discharges per DA-group are counted
• Clinical and day treatments are added
• Index per DA-group
• Discharges yr t / Discharges yr t 1
• Weights for DA-indices
• Hospitalisation days
• Annually adjusted

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Index for other services

• Outpatient Visits yr t / visits yr t 1
• Similar index for remaining services
• Treatments yr t / treatments yr t 1
• Blood takings yr t / blood takings yr t 1
• Births yr t / births yr t 1

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Overall Laspeyres index

• Clinical and day (D)
• Other services (R)
• Overall index

Cost weights
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Output general hospitals
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Other health sectors

• NA use a C-method for
• Nursing homes
• Homes for elderly
• Home health care
• Psychiatric institutes
• Institutes for disabled
• Total budget covers 3.5 of Dutch GDP
• Is a B-method possible?

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Production data

• Example Nursing homes
• Main output Nursing days
• Product composition changes over time
• New products added (home care, assistance)
• Changes of same product

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How to make an index?

• Nursing days can be tracked yearly
• How to incorporate new products?

Nursing homes Nursing homes Nursing homes Nursing homes
Year Budget Days of budget
1998 100 100 80.9
1999 103.7 100.3 81.6
2000 107.9 102.2 82.9
2001 134.5 104.7 72.4
2002 148.8 107.7 71.5
2003 161.4 110.1 72.2
Source CTG Source CTG Source CTG Source CTG
New products!
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Labour productivity

• Sector General hospitals
• LP Output / Labour input
• Labour input
• Measured in ftes
• Correction for sick and maternity leave
• Differentiation by profession group
• Group weights based on salaries

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Labour productivity Results
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Comparison with other sectors
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Future plans

• Health output
• Development of output index for other sectors
• How to deal with new products?
• Integration with method for hospitals
• Labour productivity
• Also for other health sectors
• Effect of uncertainties

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Questions?
Domande?
Preguntas?
Vragen?
Spørsmåler?
Fragen?
Questions?
Preguntas?
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For more info

• Antonio Chessa
• Statistics Netherlands (CBS)
• Tel. [phone]
• E-mail acsa_at_cbs.nl
• http//www.cbs.nl