Gutacker Nils, Street Andrew
Centre for Health Economics, University of York, York, UK.
Health Econ. 2018 Feb;27(2):e13-e27. doi: 10.1002/hec.3554. Epub 2017 Aug 18.
Public sector organisations pursue multiple objectives and serve a number of stakeholders. But stakeholders are rarely explicit about the valuations they attach to different objectives, nor are these valuations likely to be identical. This complicates the assessment of their performance because no single set of weights can be chosen legitimately to aggregate outputs into unidimensional composite scores. We propose the use of dominance criteria in a multidimensional performance assessment framework to identify best practice and poor performance under relatively weak assumptions about stakeholders' preferences. We use as an example providers of hip replacement surgery in the English National Health Service and estimate multivariate multilevel models to study their performance in terms of length of stay, readmission rates, post-operative patient-reported health status and waiting time. We find substantial correlation between objectives and demonstrate that ignoring the correlation can lead to incorrect assessments of performance.
公共部门组织追求多个目标，并服务于众多利益相关者。但利益相关者很少明确说明他们对不同目标的重视程度，而且这些重视程度也不太可能相同。这使得对其绩效的评估变得复杂，因为无法合理地选择单一的权重集来将产出汇总为一维综合得分。我们建议在多维度绩效评估框架中使用优势标准，以便在关于利益相关者偏好的相对较弱假设下识别最佳实践和不良绩效。我们以英国国家医疗服务体系中髋关节置换手术的提供者为例，估计多元多层次模型，以研究他们在住院时间、再入院率、术后患者报告的健康状况和等待时间方面的表现。我们发现目标之间存在显著相关性，并证明忽略这种相关性可能导致对绩效的错误评估。
