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

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Author Info
Maria Goddard (Centre for Health Economics, University of York, UK)
Russell Mannion (Centre for Health Economics, University of York, UK)
Peter Smith

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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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Publisher Info
Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 9 (2000)
Issue (Month): 2 ()
Pages: 95-107
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Handle: RePEc:wly:hlthec:v:9:y:2000:i:2:p:95-107

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Darvish, Tikva & Kahana, Nava, 1989. "The ratchet principle : A multi-period flexible incentive scheme," European Economic Review, Elsevier, vol. 33(1), pages 51-57, January. [Downloadable!] (restricted)
  2. repec:att:wimass:199610 is not listed on IDEAS
  3. Maria Goddard & Russell Mannion, 1998. "From competition to co-operation: new economic relationships in the National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 105-119.
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. 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. [Downloadable!]
  2. 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. [Downloadable!] (restricted)
  3. Abigail Barr & Magnus Lindelow & Pieter Serneels, 2004. "To Serve The Community Or Oneself: The Public Servant'S Dilemma," Development and Comp Systems 0409035, EconWPA. [Downloadable!]
    Other versions:
  4. Pascal Courty & Gerald Marschke, 2003. "Making Government Accountable: Lessons from a Federal Job Training Program," The Centre for Market and Public Organisation 03/083, Department of Economics, University of Bristol, UK. [Downloadable!]
    Other versions:
  5. G. Fiorentini & E. Iezzi & M. Lippi Bruni & C. Ugolini, 2009. "Incentives In Primary Care and Their Impact on Potentially Avoidable Hospital Admissions," Working Papers 660, Dipartimento Scienze Economiche, Universita' di Bologna. [Downloadable!]
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