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Efficiency and productivity gains of robotic surgery: The case of the English National Health Service

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  • Laia Maynou
  • Alistair McGuire
  • Victoria Serra‐Sastre

Abstract

This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on‐going maintenance costs. Using data from Hospital Episode Statistics for the period 2000–2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic‐assisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference‐in‐difference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in post‐LoS and 44% and 46% decrease in postoperative visits after 1 year and 2 years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the large‐scale hospital investments in such costly technology.

Suggested Citation

  • Laia Maynou & Alistair McGuire & Victoria Serra‐Sastre, 2024. "Efficiency and productivity gains of robotic surgery: The case of the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1831-1856, August.
  • Handle: RePEc:wly:hlthec:v:33:y:2024:i:8:p:1831-1856
    DOI: 10.1002/hec.4838
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    1. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
    2. Jinhyung Lee & Jeffrey S. McCullough & Robert J. Town, 2013. "The impact of health information technology on hospital productivity," RAND Journal of Economics, RAND Corporation, vol. 44(3), pages 545-568, September.
    3. repec:hal:spmain:info:hdl:2441/170cd4sul89ddpnfuomvfm0jc0 is not listed on IDEAS
    4. Philippe Aghion & Céline Antonin & Simon Bunel & Xavier Jaravel, 2020. "What Are the Labor and Product Market Effects of Automation? New Evidence from France," SciencePo Working papers Main hal-03403062, HAL.
    5. Karine Lamiraud & Stephane Lhuillery, 2016. "Endogenous Technology Adoption and Medical Costs," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1123-1147, September.
    6. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    7. Wolfgang Dauth & Sebastian Findeisen & Jens Suedekum & Nicole Woessner, 2021. "The Adjustment of Labor Markets to Robots [“Skills, Tasks and Technologies: Implications for Employment and Earnings]," Journal of the European Economic Association, European Economic Association, vol. 19(6), pages 3104-3153.
    8. Andrew Street & Padraic Ward, 2009. "NHS input and productivity growth 2003/4 - 2007/8," Working Papers 047cherp, Centre for Health Economics, University of York.
    9. Horn, Danea & Sacarny, Adam & Zhou, Annetta, 2022. "Technology adoption and market allocation: The case of robotic surgery," Journal of Health Economics, Elsevier, vol. 86(C).
    10. Daron Acemoglu & Pascual Restrepo, 2020. "Robots and Jobs: Evidence from US Labor Markets," Journal of Political Economy, University of Chicago Press, vol. 128(6), pages 2188-2244.
    11. Olley, G Steven & Pakes, Ariel, 1996. "The Dynamics of Productivity in the Telecommunications Equipment Industry," Econometrica, Econometric Society, vol. 64(6), pages 1263-1297, November.
    12. Maynou, Laia & Pearson, Georgia & McGuire, Alistair & Serra-Sastre, Victoria, 2022. "The diffusion of robotic surgery: examining technology use in the English NHS," LSE Research Online Documents on Economics 114535, London School of Economics and Political Science, LSE Library.
    13. Daniel A. Ackerberg & Kevin Caves & Garth Frazer, 2015. "Identification Properties of Recent Production Function Estimators," Econometrica, Econometric Society, vol. 83, pages 2411-2451, November.
    14. Ryan C. McDevitt & James W. Roberts, 2014. "Market structure and gender disparity in health care: preferences, competition, and quality of care," RAND Journal of Economics, RAND Corporation, vol. 45(1), pages 116-139, March.
    15. Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
    16. repec:hal:spmain:info:hdl:2441/3n1gbsj6rs80ipqv9d42nfd0ge is not listed on IDEAS
    17. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    18. Gaynor, Martin & Anderson, Gerard F., 1995. "Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds," Journal of Health Economics, Elsevier, vol. 14(3), pages 291-317, August.
    19. James Levinsohn & Amil Petrin, 2003. "Estimating Production Functions Using Inputs to Control for Unobservables," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 70(2), pages 317-341.
    Full references (including those not matched with items on IDEAS)

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