Accountability and incentives: The impacts of dierent regimes on hospitalwaiting times in England and Wales

Improving accountability in public services has been a central ob-jective of many public sector reforms in recent years. Chief amongthese have been efforts to generate observable performance measuresas a basis for monitoring performance. This paper examines a nat-ural experiment in regimes applied to waiting list targets for hospitaladmissions in England and Wales. Prior to 2001, each country hadsimilar policies, organisational structures for hospital care, and levelsof resources. After 2001, the principal difference between the coun-tries were the consequences for hospitals that failed to meet targets forwaiting times: in England, failure resulted in sanctions in a process of`naming and shaming', but in Wales, failure was perceived to result inextra resources. We use hospitals in Wales as a 'control group', to ex-amine the effect of `naming and shaming' in England. We found thatthis policy did indeed reduce waiting times in England as comparedwith Wales. However, there is some evidence there was in England,initially, some shuffing of prospective patients to meet specic targetswhich increased mean waiting times.