Excavating health care policy: are league tables likely to dig out the truth about hospital performance or dig it in?

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Abstract
This paper considers the extent to which the publication of performance data on aspects of activity within the health service illuminates, or inhibits, judgments as to its effectiveness. In order to set the question of league tables into a wider perspective their use in relation to schools, and the impact of that initiative, is considered first. Research is shown to be sceptical as to the degree to which performance data can act as a proxy for institutional effectiveness. Misgivings centre around the criteria that determine, and the adequacy of the definition of, effectiveness together with concerns that the debate is at heart a political, not a professional one. In considering the question of the publication of performance data in the health service the same three issues, concerning the criteria determining, the definition of, and the politics of, effectiveness are applied. It is concluded that a case exists for the publication of data concerning institutions funded by the taxpayer, provided the information published does concentrate on institutional effectiveness, rather than serving as an attack on professional groups or as a distraction from concern about levels of expenditure.

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