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Enhancing performance in health care: a theoretical perspective on agency and the role of information

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  • Maria Goddard
  • Russell Mannion
  • Peter Smith

Abstract

This paper examines the role of information in securing control of health care systems. The discussion focuses on the impact of the proposed ‘Performance Framework’, which entails a significant increase in the importance attached to formal performance indicators in the management of the UK National Health Service. The paper starts with a discussion of the role of performance data in securing organizational control within health care systems and summarizes recent research into the behavioural consequences of seeking to control health care agents using such information. A theoretical principal/agent model is then used to illustrate the incentives that exist for dysfunctional behaviour within health care when only imperfect information systems are available. The theoretical results are then examined in the context of a qualitative empirical study, which elicited the perceptions of managers and health care professionals connected with eight NHS hospitals. The study confirmed the existence and importance of serious dysfunctional consequences arising from the use of information as a means of control, and concludes that the Performance Framework will be successful only if it is used in careful conjunction with other means of control. Copyright © 2000 John Wiley & Sons, Ltd.

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  • Maria Goddard & Russell Mannion & Peter Smith, 2000. "Enhancing performance in health care: a theoretical perspective on agency and the role of information," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 95-107, March.
    • Handle: RePEc:wly:hlthec:v:9:y:2000:i:2:p:95-107
    DOI: 10.1002/(SICI)1099-1050(200003)9:2<95::AID-HEC488>3.0.CO;2-A
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    2. Kristensen, Søren Rud & Siciliani, Luigi & Sutton, Matt, 2016. "Optimal price-setting in pay for performance schemes in health care," Journal of Economic Behavior & Organization, Elsevier, vol. 123(C), pages 57-77.
    3. Gianluca Fiorentini & Elisa Iezzi & Matteo Lippi Bruni & Cristina Ugolini, 2011. "Incentives in primary care and their impact on potentially avoidable hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 297-309, August.
    4. Ali Uyar & Cemil Kuzey & Merve Kilic & Abdullah S. Karaman, 2021. "Board structure, financial performance, corporate social responsibility performance, CSR committee, and CEO duality: Disentangling the connection in healthcare," Corporate Social Responsibility and Environmental Management, John Wiley & Sons, vol. 28(6), pages 1730-1748, November.
    5. Sonali Das & Ming‐Hui Chen & Nicholas Warren & Michael Hodgson, 2011. "Do associations between employee self‐reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equatio," Health Economics, John Wiley & Sons, Ltd., vol. 20(12), pages 1507-1522, December.
    6. Peter C. Smith & Andrew Street, 2012. "Concepts and Challenges in Measuring the Performance of Health Care Organizations," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 32, Edward Elgar Publishing.
    7. Antti Peltokorpi, 2011. "How do strategic decisions and operative practices affect operating room productivity?," Health Care Management Science, Springer, vol. 14(4), pages 370-382, November.
    8. Adele Caldarelli & Clelia Fiondella & Marco Maffei & Rosanna Spanò & Massimo Aria, 2013. "CEO performance evaluation systems: empirical findings from the Italian health service," Public Money & Management, Taylor & Francis Journals, vol. 33(5), pages 369-376, September.
    9. Joanna Coast, 2001. "Citizens, their agents and health care rationing: an exploratory study using qualitative methods," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 159-174, March.
    10. Pascal Courty & Gerald Marschke, 2003. "Making Government Accountable: Lessons from a Federal Job Training Program," The Centre for Market and Public Organisation 03/083, The Centre for Market and Public Organisation, University of Bristol, UK.
    11. Ssengooba, Freddie & McPake, Barbara & Palmer, Natasha, 2012. "Why performance-based contracting failed in Uganda – An “open-box” evaluation of a complex health system intervention," Social Science & Medicine, Elsevier, vol. 75(2), pages 377-383.
    12. Gross, Revital, 2004. "A consumer-based tool for evaluating the quality of health services in the Israeli health care system following reform," Health Policy, Elsevier, vol. 68(2), pages 143-158, May.
    13. Kuhn, Michael & Siciliani, Luigi, 2007. "Performance Indicators for Quality with Adverse Selection, Gaming and Inequality Aversion," CEPR Discussion Papers 6261, C.E.P.R. Discussion Papers.
    14. Houyuan Jiang & Zhan Pang & Sergei Savin, 2012. "Performance-Based Contracts for Outpatient Medical Services," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 654-669, October.
    15. Nils Gutacker & Andrew Street, 2015. "Multidimensional performance assessment using dominance criteria," Working Papers 115cherp, Centre for Health Economics, University of York.
    16. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    17. Meijboom, Bert & de Haan, Job & Verheyen, Piet, 2004. "Networks for integrated care provision: an economic approach based on opportunism and trust," Health Policy, Elsevier, vol. 69(1), pages 33-43, July.
    18. Shimaa Elkomy & Graham Cookson, 2020. "Performance Management Strategy: Waiting Time in the English National Health Services," Public Organization Review, Springer, vol. 20(1), pages 95-112, March.
    19. Noto, Guido & Belardi, Paolo & Vainieri, Milena, 2020. "Unintended consequences of expenditure targets on resource allocation in health systems," Health Policy, Elsevier, vol. 124(4), pages 462-469.
    20. Michael Kuhn & Luigi Siciliani, 2009. "Performance Indicators for Quality with Costly Falsification," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 18(4), pages 1137-1154, December.

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