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Home » Research Projects » Targets and Waiting Times: Exploring a Quasi-experiment to Evaluate the use of Targets in the Provision of Health Care in the UK

Target practice?

How are health care targets met? Does success come at a cost - and who pays?

The efficacy of targets as an instrument of public and private management has been a subject of social science research for more than seventy years, with much having been written about ‘ratchet effects’, ‘threshold effects’ and output distortions from such instruments. Heavy emphasis on public service targets in several countries during the 1990s and 2000s, particularly in England, brought the subject of targets into popular debate in politics and the media.

Divergence of practice in health service management between Scotland and England since devolution to Scotland in 1999 provides us with the basis for a natural experiment for assessing the effects of targets on hospital performance. That is because the English system in the 2000s relied heavily on management through ‘targets and terror’, while the Scottish regime placed less emphasis on those instruments and put more emphasis on co-operation and collaboration.

Accordingly, this study will assemble comparable data on NHS hospital activity in Scotland and England and analyze the data to estimate the impact of targets on all hospital activity, and their overall effect on welfare.

What the research means for policymakers and the wider community

There will be three main beneficiaries from this study:

Research Methods

The study will consist of quantitative analysis and will:

Project Outputs and Related Webpages

 

Propper C., Sutton, M., Whitnall, C.,and Windmeijer, F., (2010) ‘Incentives and targets in hospital care: Evidence from a natural experiment’ Journal of Public Economics, Vol94, Issues 3-4 : Pages 318-335

Propper, C., Sutton, M., Whitnall, C. and Windmeijer, F., (2008) ‘Did ‘Targets and Terror’ Reduce Waiting Times in England for Hospital Care?,’ The B.E. Journal of Economic Analysis & Policy,  8  (2) Contributions - Article 5.

Programme Discussion Paper 0706 (December 2007): Did ‘targets and terror’ reduce waiting times in England for hospital care?

Carol Propper, Matt Sutton, Carolyn Whitnall and Frank Windmeijer (2008) Incentives and Targets in Hospital Care:
Evidence from a Natural Experiment, CMPO Working Paper No. 08/205

Carol Propper has produced a podcast on the findings from this project.

This project has been featured in an article in the Financial Times.

Research Team

Frank Windmeijer

Frank Windmeijer

Frank Windmeijer is Professor of Econometrics at the University of Bristol and Research Fellow at the Centre for Microdata Methods and Practices. Recent publications include a study of Pharmaceutical promotion and GP prescription behaviour and an analysis of waiting lists, waiting times and admissions in the Scottish health service.

Email: F.Windmeijer@bristol.ac.uk

Carol Propper

Carol Propper

Carol Propper is Professor of Economics at the University of Bristol and co-Director of the Centre for Social Exclusion at the LSE. She has worked extensively on the impact of economic incentives on the behaviour of health care suppliers.

Email: Carol.Propper@bristol.ac.uk

Matt Sutton

Matt Sutton

Matt Sutton is Professor of Health Economics at the University of Manchester. His research interests are in applied microeconometrics, resource allocation formulae, labour economics, financial incentives and equity in health and health care.

Email: Matthew.Sutton@manchester.ac.uk

Shelley Farrar

Shelley Farrar

Shelley Farrar is Research Fellow in the Health Economics Research Unit at the University of Aberdeen. She has undertaken an evaluation of the Performance Assessment Framework used in the NHS in Scotland and is currently leading the evaluation of the introduction of Payment by Results, a new activity-based financing system for the NHS in England.

Email: s.farrar@abdn.ac.uk