Incentives and targets in hospital care: Evidence from a natural experiment
Incentives and targets in hospital care: Evidence from a natural experiment
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医院护理的激励措施和目标：来自自然实验的证据
DOI：
10.1016/j.jpubeco.2010.01.002
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发表时间：
2010
影响因子：
9.8
通讯作者：
Propper C
中科院分区：
文献类型：
--
作者：
Propper C
绩效目标通常用于公共部门，尽管当组织有多个目标且绩效难以衡量时，绩效目标存在众所周知的问题。如果人们就绩效需要改进达成了相当多的共识，那么这些目标可能会发挥作用。我们通过检查英国国家医疗服务体系对引人注目的等待时间目标的反应来调查这种可能性。我们利用英国两个国家（英格兰和苏格兰）之间的自然政策实验来确定目标的全球有效性。然后，我们使用英格兰内部医院分析来确认反应因治疗强度而异，并控制可能伴随目标的资源差异。我们发现，目标实现了减少等待时间的目标，而没有将活动从其他监控较差的医疗保健方面转移，也没有降低患者出院时的健康状况。
Performance targets are commonly used in the public sector, despite their well known problems when organisations have multiple objectives and performance is difficult to measure. It is possible that such targets may work where there is considerable consensus that performance needs to be improved. We investigate this possibility by examining the response of the English National Health Service to high profile waiting time targets. We exploit a natural policy experiment between two countries of the UK (England and Scotland) to establish the global effectiveness of the targets. We then use a within-England hospital analysis to confirm that responses vary by treatment intensity and to control for differences in resources which may accompany targets. We find that targets met their goals of reducing waiting times without diverting activity from other less well monitored aspects of health care and without decreasing patient health on exit from hospital.