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

Area of Science:

• Health Services Research
• Public Policy
• Behavioral Economics

Background:

• Traditional drivers of healthcare performance improvement, such as competition or altruism, lack empirical support.
• Existing evidence does not validate the efficacy of market-based reforms or trust-based systems in enhancing healthcare quality.

Purpose of the Study:

• To investigate the motivational factors driving improved healthcare performance.
• To explore the impact of reciprocal altruism, coupled with reputational consequences, on healthcare service delivery.

Main Methods:

• Analysis of natural experiments in Italy and the United Kingdom focusing on public reporting and benchmarking.
• Examination of ethnographic research from Zambia to understand the role of reputation in service provision.
• Exploration of a novel approach combining reputational rewards and sanctions for healthcare providers.

Main Results:

• Public benchmarking effectively reduces poor national healthcare performance via 'naming and shaming'.
• Competitive benchmarking and peer learning enhance good sub-national healthcare performance.
• Reputational effects are significant motivators for healthcare providers, as evidenced by research in Zambia.

Conclusions:

• Public reporting and benchmarking represent a viable, non-monetary strategy for improving healthcare performance.
• Policy-makers can leverage 'naming and shaming' and 'competitive benchmarking' to drive service quality improvements.
• Reputational incentives are powerful tools for motivating healthcare providers to enhance public services.