Public management reform and citizen perceptions of the UK health system

Abstract

The United Kingdom (UK) instituted a performance framework for the National Health Service (NHS) in the late 1990s that, inspired by the New Public Management (NPM), employed performance measurement and management in an effort to improve the quality of health services to citizens, in addition to realizing efficiency goals. Using data from the 1996 and 2002 Eurobarometer and a difference in differences analytical approach, we evaluate the impacts of these performance reforms by comparing the UK to other European Union countries in terms of overall citizen satisfaction with the health care system and perceptions of how well the health care system performs. In general, our results suggest that citizen satisfaction and performance perceptions in the UK were more favorable after the reforms than what would have occurred, absent the implementation of the reforms. The estimated improvement in satisfaction and perceived performance is both statistically and substantively significant, and thus provides evidence that the UK’s NPM-inspired performance framework did accomplish at least some of its goals.

Points for practitioners

The New Public Management and performance measurement movements in public administration have called for a focus on customer service and citizen satisfaction. We evaluate the effects of performance-focused reforms in the health care system in the UK over time in comparison to other EU countries. Our results suggest that the quality and customer-focused aspects of New Public Management that were applied through the UK’s health system reforms seem to have improved citizen satisfaction with health care and perceived performance of the health system. Practitioners’ efforts to measure, report, and improve quality may have noticeable effects on citizens’ attitudes.