Performance Regimes in Health Care: Institutions,Critical Junctures and the Logic of Escalation in England and the Netherlands

Abstract

The Netherlands and England are near neighbours whose health care systems have much in common and whose health policy communities have also usually been well aware of what is going on in the other country. Nevertheless, for the two decades from 1982, England adopted and repeatedly redeveloped performance indicator (PI) systems in the health care field while the Netherlands virtually shunned them. A broad institutional explanation for this divergence is provided by England’s majoritarian and adversarial political system that leaves governments with fewer constraints and compromises than in the more consociational Dutch system. More recently, however, a Dutch national system of health care PIs has appeared, suggesting that this explanation needs to be supplemented. This paper draws on an empirical study of PI systems in the two countries over the period from 1982 to 2007 to suggest that two further factors are at work. Established institutional patterns may be disrupted by ‘punctuations’, while technical and political factors endogenous to PI systems may exert a logic of their own.