This problem audits the central unresolved question left by Albert Meijer's 2007 study of Dutch Web publications of public-sector performance results (secondary-school 'Quality Cards' and hospital 'Waiting List Monitors'): when a government publishes a limited set of quantitative performance indicators on the Internet, do the observed improvements represent real gains in service effectiveness, or do they reflect gaming of the published indicators, while the longer-term consequences for service dimensions left unmeasured remain unknown? Meijer's exploratory qualitative cases could not decide this and called for rigorous quantitative impact studies. Later literature supplies conflicting sector-specific evidence — welfare-reducing provider selection under US cardiac surgery report cards, genuine hygiene improvement under Los Angeles restaurant grade cards, no overall quality improvement under German mandatory hospital reporting, quasi-experimental evidence that competition did not worsen grade inflation in Danish schools, and ranking-induced air-quality gains in China — but no study isolates the effect of Internet publication for public-service performance reporting, none cleanly separates gaming from genuine improvement, and the longitudinal effects on unmeasured dimensions remain essentially unstudied. The question is therefore open.

Background

Since the 1990s, governments have published quantitative performance indicators — measured scores such as exam pass rates, waiting times, or complication rates — for schools, hospitals, and other public services, first in reports and later on the Internet. The underlying accountability model assumes a causal chain: published information is read by citizens, who then exert choice pressure or democratic accountability on service organizations, which respond by improving the measured outcomes. A long-standing concern in performance measurement, often associated with Goodhart's law (when a measure becomes a target it ceases to be a good measure), is that organizations under publication pressure may instead improve the indicator without improving the underlying service — by grade inflation, by 'creaming' (selecting easier clients and deflecting harder ones), or by public-relations management. This behavior is usually called gaming. Albert Meijer's 2007 article in Government Information Quarterly examined two prominent Dutch Web publications: the School Inspection Service's 'Quality Cards' for secondary schools and the National Health Care Institute's Waiting List Monitor for hospitals. On the demand side he found limited direct use by citizens, with intermediaries such as the local press, teachers, and health insurers acting as the effective audience; on the supply side he found organizations that anticipated stakeholder reactions and pursued higher indicator scores, including reported grade inflation in schools and creaming in hospitals. Because the design was exploratory and qualitative (case selection biased toward high-profile Web sites, no user-level usage data beyond hit counts, reliance on perceptions), the study could not establish whether publication caused real effectiveness gains, and it explicitly posed the need for rigorous quantitative impact studies. Causal evidence from adjacent settings existed and has since grown, with conflicting signs: cardiac surgery 'report cards' in New York and Pennsylvania led providers to avoid the sickest patients and, on net, worsened outcomes for them (Dranove, Kessler, McClellan and Satterthwaite, 2003); mandatory restaurant hygiene grade cards in Los Angeles improved hygiene and reduced foodborne-illness hospitalizations relative to the rest of California (Jin and Leslie, 2003, with robustness debates in their 2019 reply); target regimes in the English National Health Service elicited documented gaming (Bevan and Hood, 2006; Hood, 2006); a systematic review of public reporting in health care found stimulation of hospital quality-improvement activity but inconsistent effects on actual effectiveness (Fung, Lim, Mattke, Damberg and Shekelle, 2008); and German mandatory hospital quality reporting from 2012 to 2019 produced no overall quality improvement, though it appears to have prevented very low quality (Bayindir and Schreyögg, 2023). None of these isolates the specific phenomenon Meijer raised: publication of public-service performance results via the Internet, with both the published indicators and independent measures of true effectiveness observable over time.

Problem Statement

Determine what publishing performance results on the Internet does to the actual effectiveness of public services. The question, posed by Meijer's 2007 study of Dutch Web publications of school Quality Cards and hospital Waiting List Monitors and still unresolved, comprises the following interrelated aspects, all of which are jointly required to resolve it: (1) estimate the causal effect of publication (as opposed to concurrent reforms or secular trends) on service outcomes; (2) distinguish genuine effectiveness gains from gaming of the published indicators — grade inflation, creaming or dumping of difficult clients, reclassification, and public-relations behavior; and (3) establish the longer-term consequences of sustained publication for the creative and social education outcomes in schooling that the published indicator set does not cover. The determination must cover both a schooling and a non-schooling public service — for example, the school Quality Cards and the hospital Waiting List Monitors examined by Meijer — so that a single-sector study does not by itself resolve the question.

References

  1. Albert Meijer (2007), 'Publishing public performance results on the Internet: Do stakeholders use the Internet to hold Dutch public service organizations to account?', Government Information Quarterly 24(1):165-185, DOI 10.1016/j.giq.2006.01.014, https://doi.org/10.1016/j.giq.2006.01.014
  2. Gwyn Bevan and Christopher Hood (2006), 'What's measured is what matters: targets and gaming in the English public health care system', Public Administration 84(3):517-538, DOI 10.1111/j.1467-9299.2006.00600.x, https://doi.org/10.1111/j.1467-9299.2006.00600.x
  3. Christopher Hood (2006), 'Gaming in Targetworld: The Targets Approach to Managing British Public Services', Public Administration Review 66(4):515-521, DOI 10.1111/j.1540-6210.2006.00612.x, https://doi.org/10.1111/j.1540-6210.2006.00612.x
  4. David Dranove, Daniel Kessler, Mark McClellan and Mark Satterthwaite (2003), 'Is More Information Better? The Effects of "Report Cards" on Health Care Providers', Journal of Political Economy 111(3):555-588, DOI 10.1086/374180, https://doi.org/10.1086/374180
  5. Ginger Zhe Jin and Phillip Leslie (2003), 'The Effect of Information on Product Quality: Evidence from Restaurant Hygiene Grade Cards', Quarterly Journal of Economics 118(2):409-451, DOI 10.1162/003355303321675428, https://doi.org/10.1162/003355303321675428
  6. Ginger Zhe Jin and Phillip Leslie (2019), 'New Evidence on Information Disclosure through Restaurant Hygiene Grading: Reply', American Economic Journal: Economic Policy 11(4):429-443, DOI 10.1257/pol.20180543, https://doi.org/10.1257/pol.20180543
  7. Constance H. Fung, Yee-Wei Lim, Soeren Mattke, Cheryl Damberg and Paul G. Shekelle (2008), 'Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care', Annals of Internal Medicine 148(2):111-123, DOI 10.7326/0003-4819-148-2-200801150-00006, https://doi.org/10.7326/0003-4819-148-2-200801150-00006
  8. Esra Eren Bayindir and Jonas Schreyögg (2023), 'Public Reporting Of Hospital Quality Measures Has Not Led To Overall Quality Improvement: Evidence From Germany', Health Affairs 42(4):566-574, DOI 10.1377/hlthaff.2022.00470, https://doi.org/10.1377/hlthaff.2022.00470
  9. Albert Meijer (2009), 'Understanding modern transparency', International Review of Administrative Sciences 75(2):255-269, DOI 10.1177/0020852309104175, https://doi.org/10.1177/0020852309104175
  10. Albert Meijer (2013), 'Understanding the Complex Dynamics of Transparency', Public Administration Review 73(3):429-439, DOI 10.1111/puar.12032, https://doi.org/10.1111/puar.12032
  11. Dennis de Kool and Victor Bekkers (2015), 'The Perceived Impact of Open Inspection Data on the Quality of Education in Dutch Primary Schools: A Parent Perspective', Social Science Computer Review 33(5):645-659, DOI 10.1177/0894439314560853, https://doi.org/10.1177/0894439314560853
  12. Martin Baekgaard, Carlos X. Lastra-Anadón, Søren Serritzlew and Kim Mannemar Sønderskov (2024), 'Gaming Over: Quasi-Experimental Evidence on the Effect of Competition on Gaming', Public Performance & Management Review 47(1):89-113, DOI 10.1080/15309576.2024.2302389, https://doi.org/10.1080/15309576.2024.2302389
  13. Lei Liu, Zhaotian Yang and Suqin Song (2021), 'Does ranking stimulate government performance? Evidence from China's key environmental protection cities', Social Indicators Research 158(2):699-725, DOI 10.1007/s11205-021-02722-7, https://doi.org/10.1007/s11205-021-02722-7