IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

Unintended Policy Impacts of Outcome-Based Measures in a New Era of Service Delivery: Examples from Preschool Immunization

Listed author(s):
  • Lynn Olson
  • Andrew Gordon
Registered author(s):

    As public programs move to block grants and other more decentralized forms of government intervention, one of the most vexing problems is accountability. A commonly suggested solution is to develop an outcome-based approach to measuring program success. One measure that is already widely used to assess the quality of children's health care is immunization rates among preschool children. This paper examines the construction and use of immunization rates and discusses the lessons learned as new performance standards are debated. We probe the details of how group rates of immunizations are constructed, and how these data are used in the process of evaluating quality of care. Immunization rates seem highly appropriate for accountability: they have strong face validity and are assumed to be a useful proxy for good preventive care for children. But when the data and the process of rate construction are examined closely, we find many ambiguities. We suggest that while data point to a recent increase in immunization rates, these higher rates do not necessarily indicate that children's access to health care has improved. We will discuss how recent efforts to increase immunization rates might have unintended and even negative consequences for the well being of children. The experience with measuring immunization rates underscores that performance measures are inherently socially constructed facts, not perfect mirrors of actions. Policy lessons include: 1) The resources and attention devoted to a measure will change over time depending on public and political interest; 2) even in the best designed projects, critical information about how data are gathered remains mysterious; 3) even seemingly simple outcomes are rarely, if ever, simple to measure; and 4) finally, and perhaps most important, documentation requirements can corrupt the social processes the records are intended to measure.

    To our knowledge, this item is not available for download. To find whether it is available, there are three options:
    1. Check below under "Related research" whether another version of this item is available online.
    2. Check on the provider's web page whether it is in fact available.
    3. Perform a search for a similarly titled item that would be available.

    Paper provided by Institute for Policy Resarch at Northwestern University in its series IPR working papers with number 96-26.

    in new window

    Date of creation:
    Handle: RePEc:wop:nwuipr:96-26
    Contact details of provider: Postal:
    2040 Sheridan Road, Evanston, IL 60208-4100

    Phone: 847-491-8712
    Web page:

    More information through EDIRC

    No references listed on IDEAS
    You can help add them by filling out this form.

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:wop:nwuipr:96-26. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Thomas Krichel)

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.