Objectives, information and incentives in the NHS internal market

In order to achieve and monitor success in the NHS internal market, it is important that information related to health care objectives is developed and used. The paper argues that these objectives are not always easy to specify but that four groups can be identified: efficiency, equity, quality and accountability/responsiveness. Although information management specialists have emphasised the construction and use of appropriate frameworks for planning information flows, whether appropriate information is used depends on the existence of incentives for its supply. Using concepts from game theory, the paper offers a non-technical examination of the incentives that the contracting environment imposes on the development of new information. The article concludes by suggesting that, for a variety of reasons, the incentives to produce information which would help monitor medical outcomes and related objectives, as distinct from inputs or activities, are often weak and sometimes perverse.