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Reputations count: why benchmarking performance is improving health care across the world


  • Bevan, Gwyn
  • Evans, Alice
  • Nuti, Sabina


This paper explores what motivates improved health care governance. Previously, many have thought that performance would either improve via choice and competition or relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary but in the form of reputational effects through public reporting of benchmarking of performance . Drawing on natural experiments in Italy and the UK, we illustrate how public benchmarking can improve poor performance at both the sub-national and national level through ‘naming and shaming’ and enhance good performance through ‘competitive benchmarking’ and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.

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  • Bevan, Gwyn & Evans, Alice & Nuti, Sabina, 2018. "Reputations count: why benchmarking performance is improving health care across the world," LSE Research Online Documents on Economics 86469, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:86469

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    References listed on IDEAS

    1. Ashton, Toni & Mays, Nicholas & Devlin, Nancy, 2005. "Continuity through change: The rhetoric and reality of health reform in New Zealand," Social Science & Medicine, Elsevier, vol. 61(2), pages 253-262, July.
    2. 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.
    3. 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.
    4. Oliver, Adam, 2015. "Incentivising improvements in health care delivery," Health Economics, Policy and Law, Cambridge University Press, vol. 10(03), pages 327-343, July.
    5. Murante, Anna Maria & Vainieri, Milena & Rojas, Diana & Nuti, Sabina, 2014. "Does feedback influence patient - professional communication? Empirical evidence from Italy," Health Policy, Elsevier, vol. 116(2), pages 273-280.
    6. Le Grand, Julian, 2003. "Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens," OUP Catalogue, Oxford University Press, number 9780199266999.
    7. Julian Le Grand, 2007. "Introduction to The Other Invisible Hand: Delivering Public Services through Choice and Competition," Introductory Chapters,in: The Other Invisible Hand: Delivering Public Services through Choice and Competition Princeton University Press.
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    JEL classification:

    • J50 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - General

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