Blunt tools: Performance measurement in policies for health care

Throughout the Western world governments have been obliged to address the tension between the continuously rising cost of publicly-financed health care and the perceived need to restrain aggregate public expenditure. In several countries recent developments have included attempts to apply ‘performance indicators’ to health care programmes. This paper examines the nature of the main US and UK indicators and argues that, though they may help to legitimate expenditure restraint, they will probably tell us little about the effectiveness (or even efficiency) of present practice. Some directions are indicated for an alternative approach to performance measurement.