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Combining leadership and incentives to improve health care: the case of the Veterans Health Administration

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Governments across the world seem to be almost perennially motivated to ‘reform’ their health care systems, with the intention of improving efficiency, equity, access, responsiveness, quality, safety and/or accountability. Moreover, their attempts are often driven by ‘learning from overseas’; a process of policy transfer. However, one has to be very careful when introducing policy developments from abroad because the success or otherwise of the policy may depend on the institutional framework of the health care system; and institutions differ across time and place. For instance, competitive forces may only be effective if hospitals are allowed to fail; and the closure of hospitals, in the context of some systems, may be politically very difficult. Furthermore, a policy to improve system performance in relation to one objective can prove detrimental to another. For example, responsiveness through more patient choice can undermine other possibly more important objectives such as equity. This may occur when the ability to exercise choice is dependent on access to resources which are not uniform across society. The United States Veterans Health Administration (VHA), a publicly financed and provided health care service for the US armed forces, is similar in its institutional structure to the UK’s National Health Service (NHS). From the mid 1990s onwards the VHA managed to achieve quite substantial improvements in some aspects of its process quality, potentially making it an interesting case for British observers to study. Two important reasons underlying the VHA’s improvements in quality were strong leadership and performance management. It is doubtful whether the improvements would have occurred had either one of these factors been missing. This paper will provide an overview of the improved performance in the VHA and describe the way leadership and performance management together facilitated this improvement.

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en

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http://eprints.lse.ac.uk/22682/

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