发表机构
University of York; London School of Economics and Political Science（约克大学; 伦敦政治经济学院）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
利用英格兰外科中心分阶段推广的双重差分估计，发现择期与急诊分离使医生生产力提高14.5%，等待时间减少10天，且独立中心和多中心效果更显著。
AI 中文摘要
择期与急诊护理的组织分离是否能提高医生生产力，仍是一个悬而未决的问题。现有证据大多依赖于横截面比较或基于数量的结果，无法将效率提升与投入扩张或提供者选择区分开来。相比之下，本文利用英格兰国民健康服务体系（NHS England）外科中心项目的分阶段推广（该项目是其择期恢复计划中引入的一组专用、隔离的择期设施），为择期-急诊分离对医生生产力的因果效应提供估计。利用这一推广实施异质性稳健的双重差分设计，我们估计了采用外科中心对医生生产力的影响，该生产力以每单位按工资加权医生投入的成本加权择期产出衡量。我们发现，与未设立中心的对照情景相比，采用外科中心使医生生产力提高了14.5%，同时平均患者等待时间减少了10天（7.6%）。这些收益的大小取决于择期护理与急诊路径的隔离程度。位于专用择期场所的独立中心比位于主要急症医院内的综合中心获得了相对更大的生产力收益。此外，运营多个中心产生的收益是总体平均值的两倍以上，而单个中心则没有显示出统计学上显著的效果。对于寻求提高医生生产力和解决择期积压问题的卫生系统，这些发现表明，分离的实施方式（而非仅仅是是否采用）决定了其带来的生产力收益。
英文摘要
Whether organisational separation of elective and emergency care improves physician productivity remains an open question. Most existing evidence relies on cross-sectional comparisons or volume-based outcomes that cannot isolate efficiency gains from input expansion or provider selection. In contrast, this paper exploits the staggered rollout of NHS England's surgical hub programme, a set of dedicated ring-fenced elective facilities introduced as part of its Elective Recovery Plan, to provide causal estimates of the effect of elective-emergency separation on physician productivity. Using this rollout to implement a heterogeneity-robust difference-in-differences design, we estimate the impact of hub adoption on physician productivity measured as cost-weighted elective output per unit of salary-weighted physician input. We find that hub adoption increases physician productivity by 14.5% relative to the no-hub counterfactual, accompanied by a 10-day (7.6%) reduction in average patient waiting times. The size of these gains depends on how completely elective care is insulated from emergency pathways. Standalone hubs situated on dedicated elective-only sites achieve relatively larger productivity gains than integrated hubs located within main acute hospital sites. Moreover, operating multiple hubs yields gains more than double the overall average, whereas a single hub shows no statistically significant effect. For health systems seeking to raise physician productivity and address elective backlogs, these findings suggest that how separation is implemented, not simply whether it is adopted, shapes the productivity gains it delivers.
Comments37 pages (plus supplementary material). Working paper
