Allied health manpower strategies: estimates of the potential gains from efficient task delegation

Journal ArticleThis study analyzes the potential impact of physician extenders on the productivity of primary care practices and considers the consequent implication for future health manpower requirements. A number of previous investigations have evaluated a variety of extenders in experimental settings. This study, in contrast, constructs and operates a simulation model of the representative practice permitting one to synthesize the experiences and insights of earlier demonstration projects. The model requires the practice to delegate tasks to paramedical personnel including the physician extender in such a way as to minimize the total cost of delivering a list of required medical services. The alternative acceptable techniques for delivering care are defined by the number of minutes of each type of medical personnel that must be employed in producing each service. Primary care is characterized by distinct medical services. The model reveals that physician extenders could increase the productivity of a representative primary care practice by up to 74 per cent. Alternatively, the commitment of physician time required to serve a patient load of 100 visits a week might be reduced by 14.2 hours through effective use of an extender. The article concludes with observations on the implications of physician extenders for future health manpower requirements

Factor productivity and income inequality: a general equilibrium analysis

Economic growth over the past two decades has failed to reduce income inequality. We contend that major reasons for this are the slowdown and bias in technological change (productivity growth). Given the complexity of the many interactions that take place, this phenomenon is best addressed in a general equilibrium context. For this purpose, we have developed a computable general equilibrium (CGE) model with advanced features relating to income distribution. We perform a series of simulations based on recent overall productivity changes, but under various forms of technological change bias, factor mobility, and government budgetary balance. We find the labour-augmenting technological change cases to be most consistent with recent experience.