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

Published online by Cambridge University Press:  16 March 2018

Gwyn Bevan*
Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, London, UK
Alice Evans
Lecturer in the Social Science of Development, Department of International Development, King’s College London, London, UK
Sabina Nuti
Professor of Health Management, Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
*Correspondence to: Gwyn Bevan, Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, London WC2A 2AE, UK. Email:


This paper explores what motivates improved health care performance. Previously, many have thought that performance would either improve via choice and competition or by 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 United Kingdom, we illustrate how public benchmarking can improve poor performance at the national level through ‘naming and shaming’ and enhance good performance at the sub-national level 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.

© Cambridge University Press 2018 

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This paper is a revised version of a paper presented at the LSEHSC International Health Policy Conference 2017, London School of Economics and Political Science, 16–19 February 2017.


Akerlof, G.A. and Kranton, R.E. (2010), Identity Economics: How Identities Shape Our Work, Wages, and Well Being, Woodstock: Princeton University Press.Google Scholar
Anonymous (2017), ‘The National Health Service: policy transplant’, Economist November 4–10, 5657.Google Scholar
Ashton, T., Mays, N. and Devlin, N. (2005), ‘Continuity through change: the rhetoric and reality of health reform in New Zealand’, Social Science & Medicine, 61(2): 253262.Google Scholar
Auditor General for Wales (2005), NHS Waiting Times in Wales. Volume 1 – The Scale of the Problem. Volume 2 – Tackling the Problem, Cardiff: The Stationery Office.Google Scholar
Ayres, I. and Braithwaite, J. (1992), Responsive Regulation: Transcending the Deregulation Debate, Oxford: Oxford University Press.Google Scholar
Barber, M. (2007), ‘Instruction to Deliver’. London: Politico’s Publishing, p. 335.Google Scholar
BBC News (2007), ‘Blair: In His Own Words’. Friday, 11 May, [26 January 2018].Google Scholar
Berwick, D. M., James, B. and Coye, M. J. (2003), ‘Connections between quality measurement and improvement’, Medical Care, 41(1): 130138.Google Scholar
Bevan, G. (2014), ‘The Impacts of Asymmetric Devolution on Health Care in the Four Countries of the UK’, [26 January 2018].Google Scholar
Bevan, G. and Hood, C. (2006), ‘What’s measured is what matters: targets and gaming in the English public health care system’, Public Administration, 84(3): 517538.Google Scholar
Bevan, G. and Hamblin, R. (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 (Statistics in Society), 172(1): 161190.Google Scholar
Bevan, G. and Skellern, M. (2011), ‘Does competition between hospitals improve clinical quality?: A review of evidence from two eras of competition in the English NHS’, BMJ, 343: d6470.Google Scholar
Bevan, G. and Fasolo, B. (2013), ‘Models of Governance of Public Services: Empirical and Behavioural Analysis of Econs and Humans’, in A. Oliver (ed.) Behavioural Public Policy, Cambridge: Cambridge University Press, 3862.Google Scholar
Bevan, G., Karanikolos, M., Exley, J., Nolte, E., Connolly, S. and Mays, N. (2014), The Four Health Systems of the United Kingdom: How Do They Compare?, London: Nuffield Trust, [26 January 2018].Google Scholar
Bowles, S. (2016), The Moral Economy: Why Good Incentives Are No Substitute for Good Citizens, London: Yale University Press.Google Scholar
Central Statistical Office (CSO), Ministry of Health, University of Zambia Teaching Hospital, University of Zambia Department of Population Studies, Tropical Diseases Research Centre (2015), The DHS Program. Zambia Demographic and Health Survey 2013-14, Lusaka: CSO.Google Scholar
Chassin, M. R. (2002), ‘Achieving and sustaining improved quality: lessons from New York State and cardiac surgery’, Health Affairs, 21(4): 4051.Google Scholar
Chowdry, H., Muriel, A. and Sibieta, L. (2008), ‘Level Playing Field? The Implications of School Funding. CfBT Education Trust’, [26 January 2018].Google Scholar
Clark, J. (2012), ‘Medical leadership and engagement: no longer an optional extra’, Journal of Health Organization and Management, 26(4): 437443.Google Scholar
Cooper, Z., Gibbons, S., Jones, S. and McGuire, A. (2011), ‘Does hospital competition save lives? Evidence from the English NHS patient choice reforms’’, The Economic Journal, 121(554): F228F260.Google Scholar
Department of Health (2002), NHS Performance Ratings. Acute Trusts, Specialist Trusts, Ambulance Trusts, Mental Health Trusts 2001/02, London: Department of Health.Google Scholar
Department of Health (2005), ‘Chief Executive’s Report to the NHS’. Statistical Supplement, May. Department of Health, London, p. 16.Google Scholar
Enthoven, A. C. (1985), Reflections on the Management of the National Health Service: An American Looks At Incentives to Efficiency in Health Services Management in the UK, London: Nuffield Provincial Hospitals Trust.Google Scholar
Evans, A. (forthcoming), ‘Amplifying accountability by benchmarking results at district and national levels’, Development Policy Review.Google Scholar
France, G. and Taroni, F. (2005), ‘The evolution of health-policy making in Italy’, Journal of Health Politics, Policy and Law, 30(1–2): 169187.Google Scholar
Frey, B. (2013), ‘How Should People be Rewarded for Their Work?’, in A. Oliver (ed.), Behavioural Public Policy, Cambridge: Cambridge University Press, 165183.Google Scholar
Fukuda-Parr, S. (2014), ‘Global goals as a policy tool: intended and unintended consequences’, Journal of Human Development and Capabilities, 15(2–3): 118131.Google Scholar
Fung, C. H., Lim, Y. W., Mattke, S., Damberg, C. and Shekelle, P. G. (2008), ‘Systematic review: the evidence that publishing patient care performance data improves quality of care’, Annals of Internal Medicine, 148(2): 111123.Google Scholar
Gaynor, M., Moreno-Serra, R. and Propper, C. (2013), ‘Death by market power: reform, competition, and patient outcomes in the National Health Service’, American Economic Journal: Economic Policy, 5(4): 134166.Google Scholar
Gintis, H., Bowles, S., Boyd, R. and Fehr, E. (eds) (2005), Moral Sentiments and Material Interest: The Foundation of Cooperation in Economic Life, Cambridge, MA: MIT Press.Google Scholar
Ham, C. (2008), ‘World class commissioning: a health policy chimera?’, Journal of Health Services Research & Policy, 13(2): 116121.Google Scholar
Hibbard, J. H. (2008), ‘What can we say about the impact of public reporting? Inconsistent execution yields variable results’, Annals of Internal Medicine, 148(2): 160161.Google Scholar
Hibbard, J. H., Stockard, J. and Tusler, M. (2003), ‘Does publicizing hospital performance stimulate quality improvement efforts?’, Health Affairs, 2(2): 8494.Google Scholar
Hibbard, J. H., Stockard, J. and Tusler, M. (2005), ‘Hospital performance reports: impact on quality, market share, and reputation’, Health Affairs, 24(4): 11501160.Google Scholar
Hood, C. and Dixon, R. (2010), ‘The political payoff from performance target systems: no-brainer or no-gainer?’, Journal of Public Administration Research and Theory. 1, 20(Supplement 2): i281i298.Google Scholar
Le Grand, J. (2003), Motivation, Agency and Public Policy: Of Knights and Knaves, Pawns and Queens, Oxford: Oxford University Press.Google Scholar
Le Grand, J. (2007), The Other Invisible Hand: Delivering Public Services Through Choice and Competition, Woodstock: Princeton University Press.Google Scholar
Le Grand, J. (2010), ‘Knights and knaves return: public service motivation and the delivery of public services’, International Public Management Journal, 13(1): 5671.Google Scholar
Maarse, H., Jeurissen, P. and Ruwaard, D. (2016), ‘Results of the market-oriented reform in the Netherlands: a review’, Health Economics, Policy and Law, 11(2): 161178.Google Scholar
Marshall, M. N., Shekelle, P. G., Leatherman, S. and Brook, R. H. (2000), ‘The public release of performance data: what do we expect to gain? A review of the evidence’, JAMA, 283(14): 18661874.Google Scholar
Miller, E. F. and Hume, D. (1994), Essays: Moral, Political, and Literary, Indianapolis, IN: Liberty Fund.Google Scholar
Ministry of Health (2008), National Reproductive Health Policy, Lusaka: MoH.Google Scholar
Mukonka, V. (2012), Status of Maternal Health in Zambia, Geneva: Countdown to 2015.Google Scholar
Mukonka, V. M., Malumo, S., Kalesha, P., Nambao, M., Mwale, R., Kasonde, M. and Wamulume, P. K. (2014), ‘Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) – the Zambian experience’, BMC Public Health, 14: 60.Google Scholar
Murante, A. M., Vainieri, M., Rojas, D. and Nuti, S. (2014), ‘Does feedback influence patient – professional communication? Empirical evidence from Italy’, Health Policy, 116(2): 273280.Google Scholar
Nuti, S., Seghieri, C. and Vainieri, M. (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, 17(1): 5969.Google Scholar
Nuti, S., Vola, F., Bonini, A. and Vainieri, M. (2015), ‘Making governance work in the health care sector: evidence from a “natural experiment” in Italy’, Health Economics, Policy and Law, 11(1): 1738.Google Scholar
Nuti, S., Bini, B., Ruggieri, T.G., Piaggesi, A. and Ricci, L. (2016), ‘Bridging the gap between theory and practice in integrated care: the case of the diabetic foot pathway in Tuscany’, International Journal of Integrated Care, 16(2): 9.Google Scholar
Oliver, A. (2007), ‘The Veterans health administration: an American success story?’, Milbank Quarterly, 85: 535.Google Scholar
Oliver, A. (2015), ‘Incentivising improvements in health care’, Health Economics, Policy and Law, 10(3): 327343.Google Scholar
Oliver, A. (2017), ‘Do unto others: on the importance of reciprocity in public administration’, American Review of Public Administration, doi: 10.1177/0275074016686826.Google Scholar
Pinnarelli, L., Nuti, S., Sorge, C., Davoli, M., Fusco, D., Agabiti, N., Vainieri, M. and Perucci, C. A. (2012), ‘What drives hospital performance? The impact of comparative outcome evaluation of patients admitted for hip fracture in two Italian regions’, BMJ Quality & Safety, 21(2): 127134.Google Scholar
Pollock, A., Macfarlane, A., Kirkwood, G., Majeed, F.A., Greener, I., Morelli, C., Boyle, S., Mellett, H., Godden, S., Price, D. and Brhlikova, P. (2011), ‘No evidence that patient choice in the NHS saves lives’, The Lancet, 378(9809): 20572060.Google Scholar
Sarwar, M. B. (2015), ‘National MDG Implementation: Lessons for the SDG Era’, Working Paper No. 428, Overseas Development Institute, London, p. 10.Google Scholar
Schultze, C. L. (2010), The Public Use of Private Interest (Quoted by Enthoven). Volume 1976. Washington: Brookings Institution Press.Google Scholar
Skellern, M. (2016), ‘The Hospital as a Multi-Product Firm: Measuring the Effect of Hospital Competition on Quality Using Patient-Reported Outcome Measures’, mimeo, June 2015, London School of Economics and Political Science, London.Google Scholar
Smee, C (2008), ‘Speaking Truth to Power’, in N. Timmins (ed.), Rejuvenate or Retire? Views of the NHS at 60. London: Nuffield Trust.Google Scholar
Smith, A. (2005), Wealth of Nations, Chicago: University of Chicago Press.Google Scholar
Smith, J. and Curry, N. (2011), ‘Commissioning’, in Dixon A., Mays N. and Jones L. (eds) Understanding New Labour’s Market Reforms of the English NHS, London: King’s Fund, 3051.Google Scholar
Spurgeon, P., Mazelan, P. M. and Barwell, F. (2011), ‘Medical engagement: a crucial underpinning to organizational performance’, Health Services Management Research, 24(3): 114120.Google Scholar
Stevens, S. (2004), ‘Reform strategies for the English NHS’, Health Affairs., 23(3): 3744.Google Scholar
Tankard, M. and Paluck, M. E. (2016), ‘Norm perception as a vehicle for social change’, Social Issues and Policy Review, 10(1): 181211.Google Scholar
Thaler, R. H. and Sunstein, C. (2009), Nudge: Improving Decisions About Health, Wealth, and Loss Aversion, London: Penguin.Google Scholar
Tuohy, C. H. (1999), Accidental logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada, Oxford: Oxford University Press.Google Scholar
Wenger, E., McDermott, R. A. and Snyder, W. (2002), Cultivating Communities of Practice: A Guide to Managing Knowledge, Boston: Harvard Business Press.Google Scholar
Wilson, D. S. (2015), Does Altruism Exist?: Culture, Genes, and the Welfare of Others, London: Yale University Press.Google Scholar
Wilson, J. Q. and Kelling, G. L. (1982), ‘Broken Windows’, in R. G. Dunham and G. P. Alpert (eds), Critical Issues in Policing: Contemporary Readings Long Grove, IL: Waveland Press, Inc., 395–407.Google Scholar
World Health Organization (WHO), UNICEF, UNFPA, World Bank Group and the United Nations Population Division (2015), ‘Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division’, WHO, Geneva, p. 77.Google Scholar