Skill Mix and Patient Outcomes: A multi-country Analysis of Heart disease and breast cancer patients

Daniel Kopasker* (Corresponding Author), M. Kamrul Islam, Jonathan Gibson, Yiu-Shing Lau, Matt Sutton, Jan Erik Askildsen, Christine Bond, Robert Francis Elliott, MUNROS team

*Corresponding author for this work

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Policymakers are becoming aware that increasing the size of the healthcare workforce is no longer the most viable way to address the increasing demand for healthcare. Consequently, a focus of recent healthcare workforce reform has been extending existing roles and creating new roles for health professionals. However, little is known of the influence on outcomes from this variation in labour inputs within hospital production functions. Using a unique combination of primary and administrative data, this paper provides evidence of associations between the composition of care delivery teams and patient outcomes. The primary data enabled the construction of a task component-based measure of skill mix. This novel measure of skill mix has the advantage of capturing how workforce planning can restructure the relative input of nurses or physicians into task components while keeping the overall level of staff fixed. The analysis focuses on specific care pathways and individual hospitals, thus controlling for an under-investigated source of heterogeneity. Additionally, stratifying by country (England, Scotland, and Norway) enabled analysis of skill mix within different health systems. We provide evidence that variations in labour inputs within the breast cancer and heart disease care pathways are associated with both positive and adverse outcomes. The results illustrate the scope for substitution of task components within care pathways as a potential method of healthcare reform.
Original languageEnglish
Pages (from-to)1074-1082
Number of pages9
JournalHealth Policy
Issue number10
Early online date30 Jul 2020
Publication statusPublished - Oct 2020

Bibliographical note

The authors also wish to thank Jan Abel Olsen and participants at the 2019 winter meeting of the Health Economists’ Study Group for helpful comments on an earlier draft of this paper. We would also like to thank all those who supported and guided this work both within the MUNROS research project team and as members of the external advisory board. The European Commission funded this research programme ‘Healthcare Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012-
305467EC. HERU is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (SGHSC). The views expressed here are those of the Unit and not necessarily those of the CSO.


  • Skill mix
  • substitution
  • health workforce
  • patient outcomes
  • production function
  • Substitution
  • Patient outcomes
  • Hospital production function
  • Health workforce
  • CARE


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