Perverse incentives and health

 The Economist writes about organ transplants in the US:

[I]f the recipient dies soon after the transplant, hospitals suffer—a key measure used to evaluate them is the survival rate of recipients a year after transplant. According to Robert Cannon, a liver-transplant surgeon ..., hospitals succeed by being excessively cautious and keeping patients with worse prospects off waiting lists. In America, lots of usable organs go unrecovered or get binned, the Economist, 16 September

It's just one example of a narrow, poorly thought-through goal that's in conflict with social well-being. In this instance, improving the financial status of hospitals worsens the health of patients. A more usual comment, though in a bizarre setting is:

An anonymous nurse involved in the case suggested that the deceased patient might not have needed the [heart] procedure in the first place. Woman propped up to look alive for family after already being declared dead at Adena Hospital, Derek Myers, Scioto Valley Guardian, 20 September

There are other examples, some of which I write about in my long piece on using the Social Policy Bond concept to improve broad, societal health outcomes. (For a shorter treatment, see here.) 

In our complex societies, we rely on numerical data to give us an idea of where we, where we are going and where we want to be going. For private sector entities, narrow, short-term financial goals are good enough, but for a country, or the world, we need broad, long-term goals whose achievement is inextricably linked to the well-being of people and the environment. Social Policy Bonds were conceived as a way of injecting the market's incentives and efficiencies into the solution of social problems, but perhaps their greater contribution would be to encourage policymakers to think more carefully about society's over-arching, long-term goals. I believe there would be more consensus over such goals than there is over the alleged means of achieving them and, further, that targeting broad goals that are meaningful to ordinary people would close the gap between policymakers and the people they are supposed to represent. There would be other advantages to the bond concept, but those are the crucial ones. Meantime, it looks very much as though the sort of Mickey Mouse micro-objectives that bedevil healthcare - and not only in the US - are worse for society than the old-fashioned way of relying on people's integrity and willingness to do the right thing.