1. The Dutch experience in measuring health output and labour productivity Antonio Chessa Foske Kleima Statistics Netherlands (CBS)

2. Outline Output index for hospitals Other health sectors (data) Labour productivity of general hospitals

3. Health output hospitals Clinical and day treatments Outpatient services Other services: o Psychiatric treatments o Rehabilitation o Outpatient births o Haemodialysis o Thrombosis services

4. Clinical and day treatments: Data Hospital Discharge Register (Dutch LMR) For every patient: o Date of birth o Diagnosis (ICD-codes) o Hospitalisation days o Clinical (≥ 24 hrs) or day treatment (< 24 hrs)

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

6. Index for other services Outpatient: Visits yr t / visits yr t – 1 Similar index for remaining services: o Treatments yr t / treatments yr t – 1 o Blood takings yr t / blood takings yr t – 1 o Births yr t / births yr t – 1

7. Overall Laspeyres index Clinical and day (D): Other services (R): Overall index: Cost weights

8. Output general hospitals

9. Other health sectors NA use a C-method for: o Nursing homes o Homes for elderly o Home health care o Psychiatric institutes o Institutes for disabled Total budget covers 3.5% of Dutch GDP Is a B-method possible?

10. Production data Example: Nursing homes Main output: Nursing days Product composition changes over time: o New products added (home care, assistance) o Changes of same product

11. How to make an index? Nursing days can be tracked yearly How to incorporate new products? Nursing homes YearBudgetDays% of budget 1998100 80.9 1999103.7100.381.6 2000107.9102.282.9 2001134.5104.772.4 2002148.8107.771.5 2003161.4110.172.2 Source: CTG New products!

12. Labour productivity Sector: General hospitals LP = Output / Labour input Labour input: oMeasured in fte’s oCorrection for sick and maternity leave oDifferentiation by profession group oGroup weights based on salaries

13. Labour productivity: Results

14. Comparison with other sectors

15. Future plans Health output: oDevelopment of output index for other sectors oHow to deal with new products? oIntegration with method for hospitals Labour productivity: oAlso for other health sectors oEffect of uncertainties

16. Questions? Fragen? Domande? Vragen? ¿Preguntas? Questions? Spørsmåler? Preguntas?

17. For more info… Antonio Chessa Statistics Netherlands (CBS) Tel.: +31 (0)70 337 4577 E-mail:acsa@cbs.nlacsa@cbs.nl http://www.cbs.nl