Plain English Summary

Background:

There are two ways to think about the performance of the NHS.  The first considers whether NHS output (number of procedures, patient treated or reduced waiting times) can be increased with existing resources and current levels of expenditure (improving technical efficiency). The second estimates the health benefits of relatively small increases in health care expenditure (marginal productivity).  To date these measures of performance have been estimated separately, in different ways and have used different data sources.  

Aims and objectives:

The aim is to understand how these measures are related and how they might be estimated together, which could, in principle, identify the scale of the potential health benefits of improving technical efficiency and the health benefits of increases in health expenditure at current or improved levels of efficiency.  

Methods:

To date, no empirical study has attempted to address both these questions at the same time or establish how they are related.  Therefore, a scoping study is required to identify suitable methods and sources of data that might allow feasible empirical work in this area.  The scoping study will include a review of the most recent work on how technical efficiency can be measured and estimated, and which measures are currently informing health policy.  

Policy relevance & dissemination:

Such estimates could better guide efforts to improve efficiency and better inform decisions about the level of expenditure.  For example, it would identify whether the same improvement in health outcomes might be achieved by either improving efficiency or by increasing expenditure and how the effects of increases in expenditure might change as the technical efficiency of the NHS improves.  A report and a project template, drawing on this scoping review, will propose feasible empirical strategies to identify the effect of technical efficiency on health outcomes and the marginal productivity of NHS expenditure, demonstrating the value of addressing both these aspects of NHS performance at the same time.