A Critique of Health System Performance Measurement

Int J Health Serv. 2015;45(4):743-61. doi: 10.1177/0020731415585987. Epub 2015 May 19.

Abstract

Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are.

Keywords: Alberta; Bourdieu; performance management.

MeSH terms

  • Budgets
  • Canada
  • Cost Control
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Health Policy
  • Health Promotion
  • Health Services Accessibility
  • Humans
  • Patient Satisfaction
  • Quality Indicators, Health Care / organization & administration*
  • State Medicine / economics
  • State Medicine / organization & administration*
  • State Medicine / standards
  • Waiting Lists