The Tyranny of Metrics

Most studies of pay-for-performance, it noted, examined process and intermediate outcomes rather than final outcomes, that is, whether the patient recovered. “Overall,” it reports, “studies with stronger methodological designs were less likely to identify significant improvements associated with pay-for-performance programs. And identified effects were relatively small.” 22 Nor was this finding new. Social scientists who studied pay-for-performance schemes in the public sector in the 1990s concluded that they were ineffective. Yet such schemes keep getting introduced: a triumph of hope over experience, or of consultants peddling the same old nostrums.