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Setting Targets for Health Care Performance

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  • Gwyn Bevan

    (London School of Economics and Political Science, UK)

Abstract

This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of 'star ratings' that was introduced from 2001 by the Department of Health to give each organisation in the NHS in England a single summary score from zero rating to three stars. Star ratings were directed at holding trusts' chief executives to account for the local delivery of national priorities through a process of 'naming and shaming', in which Chief Executives of zero-rated organisations were at risk of losing their jobs. This paper outlines the underlying model and its three underlying assumptions: the centre can determine a scoring system to prioritise what matters; failures of performance that are not reflected in the scoring system do not matter; and the advantages of a system of scoring on accountable targets outweigh the disadvantages of various types of gaming responses. This paper examines the application of the model of star ratings to a case study of Primary Care Trusts (PCTs), which are complex organisations with three diverse sets of responsibilities: delivering primary care, commissioning secondary care, and supervising public health. It outlines an alternative model and the issues this raises for governance of health care performance.

Suggested Citation

  • Gwyn Bevan, 2006. "Setting Targets for Health Care Performance," National Institute Economic Review, National Institute of Economic and Social Research, vol. 197(1), pages 67-79, July.
    • Handle: RePEc:sae:niesru:v:197:y:2006:i:1:p:67-79
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    Citations

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    Cited by:

    1. Besley, Timothy & Burchardi, Konrad B. & Bevan, Gwen, 2009. "Naming and shaming: the impacts of different regimes on hospital waiting times in England and Wales," LSE Research Online Documents on Economics 33775, London School of Economics and Political Science, LSE Library.
    2. Morton, Alec & Bevan, Gwyn, 2008. "What's in a wait: Contrasting management science and economic perspectives on waiting for emergency care," Health Policy, Elsevier, vol. 85(2), pages 207-217, February.
    3. Kendall, Kathleen & Wiles, Rose, 2010. "Resisting blame and managing emotion in general practice: The case of patient suicide," Social Science & Medicine, Elsevier, vol. 70(11), pages 1714-1720, June.
    4. Sabina Nuti & Chiara Seghieri & Milena Vainieri, 2013. "Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience," Journal of Management & Governance, Springer;Accademia Italiana di Economia Aziendale (AIDEA), vol. 17(1), pages 59-69, February.
    5. Gwyn Bevan & Richard Hamblin, 2009. "Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 172(1), pages 161-190, January.

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