The Tyranny of Metrics

When metrics used for public rankings or pay-for-performance do affect outcomes, it is often in ways that are unintended and counterproductive. And whether productive or unproductive, they typically involve huge costs, costs that are rarely considered by the advocates of pay-for-performance or transparency metrics. Among the intrinsic problems of P4P and public rankings are goal diversion. As a report from Britain notes, P4P programs “can reward only what can be measured and attributed, a limitation that can lead to less holistic care and inappropriate concentration of the doctor’s gaze on what can be measured rather than what is important.” The British P4P program led to lower quality of care for those medical conditions that were not part of the program. In short, it leads to “treating to the