The “Genome” of Health Care Delivery Innovation: Productivity Research

The Harvard/Kennedy School Health Care Delivery Policy Program (HCDP) seeks to understand what changes would be needed to move the US health care delivery system toward a system that is effective, accessible, efficient and integrated. Measurement of the benefits and costs of medical care services is central to this effort, and a productivity research group is among the core research projects associated with the Program. Indeed, Jerome Grossman, Director of the HCDP, sees productivity research as “the genome of health care delivery.” Now is the right time to invest a significant amount of resources in a focused set of projects to create a core knowledge base for designing the health care delivery system, not unlike how research on the human genome has created a core knowledge base for clinical science. If we wish to design a delivery system to achieve efficiency and quality, we must be able to measure efficiency and quality. Yet in the current US health care system, we do not measure, report, nor act on such a measure of productivity. For example, in treating a patient with diabetes, the payment and accountability systems do not focus on the key health question, “did the patient get better?” but rather, “did the patient receive a lab test, a visit, etc.?” This system leads to misalignment of incentives and inefficiency. There is an ambitious and well-defined research agenda within health economics on price indices and productivity in health care (e.g., Berndt et al. 2001; Newhouse 2001). Much of the research focuses on questions of the appropriate measure of