Working Paper: CEPR ID: DP7306
Authors: Timothy J. Besley; Gwyn Bevan; Konrad B. Burchardi
Abstract: Improving accountability in public services has been a central objective of many public sector reforms in recent years. Chief among these have been efforts to generate observable performance measures as a basis for monitoring performance. This paper examines a natural experiment in regimes applied to waiting list targets for hospital admissions in England and Wales. Prior to 2001, each country had similar policies, organisational structures for hospital care, and levels of resources. After 2001, the principal difference between the countries were the consequences for hospitals that failed to meet targets for waiting times: in England, failure resulted in sanctions in a process of `naming and shaming', but in Wales, failure was perceived to result in extra resources. We use hospitals in Wales as a 'control group', to examine the effect of `naming and shaming' in England. We found that this policy did indeed reduce waiting times in England as compared with Wales. However, there is some evidence there was in England, initially, some shuffling of prospective patients to meet specific targets which increased mean waiting times.
Keywords: hospital waiting times; targets
JEL Codes: H11; I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Introduction of waiting time targets in England (C41) | Reduction in hospital waiting times in England (C41) |
| Naming and shaming regime (P37) | Reduction in hospital waiting times in England (C41) |
| Sanctions for failure to meet waiting time targets (C41) | Reduction in hospital waiting times in England (C41) |
| Waiting time targets in England (C41) | Behavioral response at the hospital level (I11) |
| Initial 'gaming' behavior in England (L83) | Increased mean waiting times for some categories (Y90) |
| Waiting time targets in England (C41) | Complex interplay of incentives and outcomes in the healthcare system (I11) |