Estimating the marginal productivity of the English National Health Service from 2003/04 to 2012/13

Estimates of the marginal productivity of the health sector are required for a wide range of resource allocation decisions. Founding these estimates on robust empirical analysis can inform these decisions and improve allocative efficiency as a result. This paper estimates the marginal productivity of the English NHS for a ten year period between 2003/04 and 2012/13. Data on expenditure and mortality by programme budget categories from this period are used in conjunction with socio-economic and demographic variables from the censuses from 2001 and 2011, as part of an econometric strategy that employs an established instrumental variable approach that is subjected to a number of sensitivity analyses. The results of the econometric analysis, along with additional data on burden of disease, are used to generate an estimate of marginal productivity. This paper finds that the point estimates of the amount of resources, in nominal terms, to produce an additional unit of health benefit has ranged from £5,000 to £15,000 per quality-adjusted life year between 2003/04 and 2012/13. These results are discussed in the context of the existing literature, and the potential policy implications for decisions about resource allocation are explored.

Keywords: productivity; econometric modelling; programme budgeting; health opportunity costs; allocative efficiency