Accountability and incentives: The impacts of different regimes on hospital waiting times in England and Wales∗

Improving accountability in public services has been a central objective of many public sector reforms in recent years. Chief among these have been efforts to generate observable performance measures as a basis for monitoring performance. This paper examines a natural experiment in regimes applied to waiting list targets for hospital admissions in England and Wales. Prior to 2001, each country had similar policies, organisational structures for hospital care, and levels of resources. After 2001, the principal difference between the countries were the consequences for hospitals that failed to meet targets for waiting times: in England, failure resulted in sanctions in a process of ‘naming and shaming’, but in Wales, failure was perceived to result in extra resources. We use hospitals in Wales as a ’control group’, to examine the effect of ‘naming and shaming’ in England. We found that this policy did indeed reduce waiting times in England as compared with Wales. However, there is some evidence there was in England, initially, some shuffling of prospective patients to meet specific targets which increased mean waiting times. ∗We are grateful to Oliver Bevan for constructing the database we have used and for comments on an earlier draft, and to staff in the Welsh Assembly Government for help in the supply of data from Welsh hospitals.