Publications
310 results found
Smith PC, Busse R, 2010, Targets and performance measurement, Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects, Pages: 509-536, ISBN: 9780521116763
Introduction Targets are a tool designed to improve health and health system performance. They can facilitate the achievement of health policy by expressing a clear commitment to achieve specified results in a defined time period and facilitating the monitoring of progress towards the achievement of broader goals and objectives. They may be quantitative (e.g. x % increase in the immunization rate) or qualitative (e.g. introduction of national screening programme); based on health outcomes (e.g. reduction in mortality) or processes (e.g. reduction of waiting time). The introduction of the concept of targets into the health sector is often traced to the 1981 publication of WHO’s Health for All strategy which presented targets as a tool with which to improve health policy (WHO Regional Office for Europe 2005). Earlier chapters of this book discuss the manifest need for tools designed to improve performance and accountability. Thus it is not surprising that targets’ role in health policy has grown and an increasing number of countries and/or regions now use them as tools to improve performance. Various mapping exercises have documented growing and sustained interest in health targets among governments and international organizations (Busse & Wismar 2002; Ritsatakis et al. 2000; van de Water & van Herten 1998). The 2005 update of the WHO European Health for All policies reported that forty-one of the (then) fifty-two Member States of the Region had either adopted or drafted policies which included health targets (WHO Regional Office for Europe 2005). Most recently, Wismar et al. (2008) offered many national and sub-national examples from Europe, primarily in population health. The Millennium Development Goals introduced important health targets at the international level.
Smith PC, Mossialos E, Papanicolas I, et al., 2010, Performance measurement for health system improvement: Experiences, challenges and prospects, ISBN: 9780521116763
In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand. It examines the various levels at which health system performance is undertaken, the technical instruments and tools available, and the implications using these may have for those charged with the governance of the health system. Technical material is presented in an accessible way and is illustrated with examples from all over the world. Performance Measurement for Health System Improvement is an authoritative and practical guide for policy makers, regulators, patient groups and researchers.
Smith PC, Mossialos E, Papanicolas I, et al., 2010, Introduction, Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects, Pages: 3-24, ISBN: 9780521116763
Introduction Information plays a central role in a health system’s ability to secure improved health for its population. Its many and diverse uses include tracking public health; determining and implementing appropriate treatment paths for patients; supporting clinical improvement; monitoring the safety of the health-care system; assuring managerial control; and promoting health system accountability to citizens. However, underlying all of these efforts is the role that information plays in enhancing decision-making by various stakeholders (patients, clinicians, managers, governments, citizens) seeking to steer a health system towards the achievement of better outcomes. Records of performance measurement efforts in health systems can be traced back at least 250 years (Loeb 2004; McIntyre et al. 2001). More formal arguments for the collection and publication of performance information were developed over 100 years ago. Pioneers in the field campaigned for its widespread use in health care but were impeded by professional, practical and political barriers (Spiegelhalter 1999). For example, Florence Nightingale and Ernest Codman’s efforts were frustrated by professional resistance and until recently information systems have failed to deliver their promised benefits in the form of timely, accurate and useful information. Nevertheless, over the past twenty-five years there has been a dramatic growth in health system performance measurement and reporting. Many factors have contributed to this growth.
Smith P, 2010, Measuring productivity in health services, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 15, Pages: 1-2, ISSN: 1355-8196
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- Citations: 4
Rice N, Robone S, Smith PC, 2010, International comparison of public sector performance: the use of anchoring vignettes to adjust self-reported data, Evaluation, Vol: 16, Pages: 81-101, ISSN: 1356-3890
Martin S, Rice N, Smith P, 2009, The Link Between Health Care Spending and Health Outcomes: Evidence from English Programme Budgeting Data
This report describes preliminary results from research funded by the Health Foundationunder its Quest for Quality and Improved Performance (QQuIP) initiative.
Martin S, Rice N, Smith P, 2009, The link between health care spending and health outcomes for the new English Primary Care Trusts
English programme budgeting data have yielded major new insights into the link between health care spending and health outcomes. This paper updates two recent studies that have used programme budgeting data for 295 Primary Care Trusts (PCTs) in England to examine the link between spending and outcomes for several programmes of care. We use the same economic model employed in the two previous studies. It focuses on a decision maker who must allocate a fixed budget across programmes of care so as to maximize social welfare given a health production function for each programme. Two equations – a health outcome equation and an expenditure equation – are estimated for each programme (data permitting). The two previous studies employed expenditure data for 2004/05 and 2005/06 for 295 health authorities and found that in several care programmes – cancer, circulation problems, respiratory problems, gastro-intestinal problems, trauma burns and injury, and diabetes – expenditure had the anticipated negative effect on the mortality rate. Each health outcome equation was used to estimate the marginal cost of a life year saved. In 2006/07 the number of PCTs in England was reduced to 152, largely through a series of mergers. In addition, several changes were made to the methods employed to construct the programme budgeting data. This paper employs updated budgeting and mortality data for the new 152 PCTs to re-estimate health production and expenditure functions, and also presents updated estimates of the marginal cost of a life year saved in each programme. Although there are some differences, the results obtained are broadly similar to those presented in our two previous studies.
Smith P, Goddard M, 2009, The English National Health Service: An Economic Health Check
The government’s health reform programme since 2000 has covered many aspects of the organisation of health care and was accompanied by a sizeable increase in spending on healthcare. Many of these reforms have the potential to improve the efficiency and responsiveness of the health care system and ultimately health outcomes, although it is too early to make definitive judgements on their effectiveness. This chapter provides an overview of the organisation and financing of the National Health Service, reviews its performance, assesses the reforms since the start of the decade and provides recommendations for further development. This Working Paper relates to the 2009 Economic Survey of the United Kingdom (www.oecd.org/eco/surveys/uk).<P>Système national de santé anglais : Bilan de santé économique<BR>Le programme de réformes engagé par le gouvernement depuis 2000 dans le secteur de la santé couvre de nombreux aspects de l’organisation des soins et services de santé et il s’est accompagné d’une augmentation notable des dépenses consacrées à la santé. Nombre de ces réformes sont de nature à améliorer l’efficience et la réactivité du système de santé et, en fin de compte, les résultats sur le plan de la santé, bien qu'il soit trop tôt pour porter des jugements définitifs sur leur efficacité. Ce chapitre donne une vue d’ensemble de l’organisation et du financement du National Health Service ; il en examine les performances et évalue les réformes conduites depuis le début de la décennie, et formule des recommandations pour la poursuite des réformes. Ce document de travail se rapporte à l'Étude économique de l'OCDE de le Royaume-Uni 2009 (www.oecd.org/eco/etudes/uk).
Epstein D, Jimenez-Rubio D, Smith PC, et al., 2009, Social determinants of health: an economic perspective, Health Economics, Vol: 18, Pages: 495-502, ISSN: 1057-9230
The World Health Organization has recently received the findings of its Commission oil the Social Determinants of Health. The Commission's report offers a remarkable summary of the evidence, and makes a passionate case for government action to address the social determinants of health, especially as they relate to health inequity. This paper summarizes the ways in which economic analysis Could strengthen policy under three headings: examining the causal impact of the determinants of health and of associated policies; prioritising actions; and determining the role of government in influencing behaviour. Copyright (c) 2009 John Wiley & Sons, Ltd.
SMITH P, 2009, PERFORMANCE INDICATORS AND OUTCOME IN THE PUBLIC-SECTOR, PUBLIC MONEY & MANAGEMENT, Vol: 15, Pages: 13-16, ISSN: 0954-0962
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- Citations: 43
Epstein D, Jimenez-Rubio D, Smith PC, et al., 2009, An economic framework for analysing the social determinants of health and health inequalities
Reducing health inequalities is an important part of health policy in most countries. This paperdiscusses from an economic perspective how government policy can influence health inequalities,particularly focusing on the outcome of performance targets in England, and the role of sectors of theeconomy outside the health service – the ‘social determinants’ of health - in delivering these targets.
Dusheiko M, Gravelle H, Martin S, et al., 2009, Does Better Disease Management in Primary Care Reduce Hospital Costs?
We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure byabout £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.
Martin S, Rice N, Smith P, 2008, Further evidence on the link between health care spending and health outcomes in England
This report describes results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative.It builds on our earlier report for the Health Foundation – The link between health care spending and health outcomes: evidence from English programme budgeting data – that took advantage of the availability of a major new dataset to examine the relationship between health care expenditure and mortality rates for two disease categories (cancer and circulation problems) across 300 English Primary Care Trusts.Our results are useful from a number of perspectives. Scientifically, they confirm our previous findings that health care has an important impact on health across a range of conditions, suggesting that those results were robust across programmes of care and across years. From a policy perspective, these results can help set priorities by informing resource allocation across a larger number of programmes of care. They also add further evidence to help NICE decide whether its current QALY threshold is at the right level.
Smith PC, 2008, Resource allocation and purchasing in the health sector: the English experience, BULLETIN OF THE WORLD HEALTH ORGANIZATION, Vol: 86, Pages: 884-888, ISSN: 0042-9686
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- Citations: 26
Castelli A, Jacobs R, Goddard M, et al., 2008, Exploring the impact of public services on quality of life indicators
The fundamental aim of public services is to improve the quality of life of citizens. The main objective of this study was to investigate the influence of public service organisations (PSOs) on aspects of quality of life (broadly measured) of citizens at a local level.We assembled a rich database using 20 of the 45 quality of life measures developed by the Audit Commission. Those we selected covered broad areas of quality of life such as safety, housing, health, education, and transport and were available at ‘small area’ level. We used a range of advanced statistical methods to analyse the relationships between PSOs and quality of life measures at different hierarchical levels. The techniques were selected to be robust when making comparisons between levels and when looking at associations between quality of life measures. Our descriptive analyses (bivariate correlations, factor analysis and ANOVA) suggested overall some significant correlations between some of the quality of life variables. The SUR model results also indicated that the quality of life indicators are correlated, and therefore that we should look at these measures in a joint modelling approach such as MVML, as envisaged in the study objectives.
Martin S, Rice N, Smith PC, 2008, Does health care spending improve health outcomes? Evidence-from English programme budgeting data, JOURNAL OF HEALTH ECONOMICS, Vol: 27, Pages: 826-842, ISSN: 0167-6296
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- Citations: 101
Jimenez-Rubio D, Smith PC, Van Doorslaer E, 2008, Equity in health and health care in a decentralised context: Evidence from Canada, HEALTH ECONOMICS, Vol: 17, Pages: 377-392, ISSN: 1057-9230
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- Citations: 41
Smith PC, Goddard M, 2008, Performance management and operational research: A marriage made in heaven?, Performance Management: Multidisciplinary Perspectives, Pages: 120-136, ISBN: 9781403947611
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- Citations: 1
Busse R, Schreyoegg J, Smith PC, 2008, Variability in healthcare treatment costs amongst nine EU countries -: Results from the <i>health</i>basket project, HEALTH ECONOMICS, Vol: 17, Pages: S1-S8, ISSN: 1057-9230
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- Citations: 56
Smith P, 2008, England: intended and unintended effects, Health targets in Europe, Editors: Wismar, McKee, Ernst, Publisher: European Observatory, ISBN: 9789289042840
Martin S, Rice N, Smith P, 2007, Risk and the GP budget holder
For most individuals, the use made of health care in a given year is determined principally by unpredictable random incidents. Of course, some individuals have a predictably higher predisposition to illness than others. However, the general consensus is that only a fraction of individual variability in health care costs can be predicted. The purpose of this paper is to explore the implications of this inherent randomness for budget setting for GP purchasers. The paper argues that variability in utilization in the NHS is very high; that no formula will ever completely capture that variability, even for large populations; that the problem of variability is likely to be very acute for a GP practice; and that health authorities and GP budget holders will therefore need to adopt a range of strategies to manage the variability.
Smith P, 2007, Performance budgeting in England: Public Service Agreements, Performance budgeting, Editors: Robinson, Publisher: Palgrave MacMillan, ISBN: 9780230553569
This book examines the theory and practice of performance budgeting, which aims to linkthe funding of government agencies to the results they deliver to ...
Smith P, 2007, Formula funding and performance budgeting, Performance budgeting, Editors: Robinson, Publisher: Palgrave MacMillan, ISBN: 9780230553569
This book examines the theory and practice of performance budgeting, which aims to linkthe funding of government agencies to the results they deliver to ...
Lunt N, Mannion R, Smith P, 2007, Economic discourse and the market: The case of community care, PUBLIC ADMINISTRATION, Vol: 74, Pages: 369-391, ISSN: 0033-3298
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- Citations: 8
Martin S, Rice N, Jacobs R, et al., 2007, The market for elective surgery: Joint estimation of supply and demand, JOURNAL OF HEALTH ECONOMICS, Vol: 26, Pages: 263-285, ISSN: 0167-6296
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- Citations: 43
Dawson D, Gravelle H, Jacobs R, et al., 2007, The effects of expanding patient choice of provider on waiting times: Evidence from a policy experiment, HEALTH ECONOMICS, Vol: 16, Pages: 113-128, ISSN: 1057-9230
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- Citations: 39
Smith P, 2007, Value for money. Increased activity may put bright future at risk., Health Serv J, Vol: 117, Pages: 18-19, ISSN: 0952-2271
Smith PC, 2007, Is the NHS providing value for money?, British Journal of Health Care Management, Vol: 13, Pages: 41-42, ISSN: 1358-0574
Smith PC, 2007, Provision of a Public Benefit Package alongside Private Voluntary Health Insurance, PRIVATE VOLUNTARY HEALTH INSURANCE IN DEVELOPMENT: FRIEND OR FOE, Editors: Preker, Scheffler, Bassett, Publisher: WORLD BANK INST, Pages: 147-167
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- Citations: 5
Jacobs R, Smith P, Goddard M, 2007, The development of composite indicators to measure health care performance, Business performance measurement: unifying theory and integrating practice, Editors: Neely, Publisher: Cambridge Univ Pr, ISBN: 9780521855112
Major update of the wide-ranging review of performance measurement, with ten new chapters covering accounting, marketing, supply-chain management and more.
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