By NextBestFitIndependent audits and few, simple measures
Keep a short list of hard-to-game measures (outcomes, patient-reported) and audit them.
Few, audited measures.
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This path
Independent audits and few, simple measures
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Audit a short list of measures
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Targets and quality metrics invite gaming
Auditing a short list of hard-to-game outcome and patient-reported measures reduces gaming and produces credible data.
What it creates or worsens
- Leaves less complete or useful data
Restricting monitoring to a short list of measures leaves fewer things measured.
- Adds paperwork, coordination, or complexity
Auditing the selected measures adds audit costs.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.
Who loses
- Hospitals, clinics, and care organizations
- Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.
Where it has been tried
- NHS England: Audits of waiting-list data after gaming.
- United Kingdom: The NAO's 2001 investigation covered nine trusts with inappropriate waiting-list adjustments and recommended investigating 13 trusts meeting both thresholds: over 10% suspended and over 2% waiting longer than twelve months.Sources: National Audit Office (2001)