Blog Political Science and Public Administration

Xavier Ballart (UAB) and Laia Monterde (UAB)


Providing measures of performance is one of the responses to the demand for accountability, transparency, good governance and quality in public administration. This book presents the development of performance measures in the health sector in Catalonia. It is organized in two parts: the first gives a critical view of the evolution and use of the measurement systems that have been implemented, and the second looks at the evolution of performance measures in the Catalan health care and the reasons for the non-publication of disaggregated performance indicators for hospitals and primary care centers, despite the availability of this information.


The book's main contribution is to analyze the reasons for this situation, which differs from that of countries such as the UK and the Netherlands (a good example for Catalonia), based on three explanations or arguments pertaining to the field of Political Science. First of all, the authors dismiss the possibility that the situation observed at the time of writing this book could be explained by a simple delay in the process of convergence in the European context, as something which would sooner or later occur in Catalonia.  In fact, health care in Catalonia has had quite dynamic and innovative public management at various stages of its recent history, which has resulted in information management systems that could allow the generation of efficiency indicators for services including more than global data on the population’s health.


Having dismissed the argument of a lag in its development, a rational explanation and a structural explanation of this process are analyzed. The first sheds light on the reasons for the initial approach adopted by the Department of Health when it assumed responsibility and faced the need to organize a very diverse and complex sector of provision of services. This rational explanation incorporates the ideas of “path dependence” and the “lock-in effect” to understand the incentive to continue with the existing system of health care management, which led successive governments of the Generalitat, including the center -left-wing government, to enhance the system of economic contracts that remained the dominant system.


But one of the main conclusions of this study is that the structural and cultural explanation is better at explaining the processes that are analyzed and also at predicting the future orientation. Catalonia has a political and administrative system that is becoming less and less dominated by one party governing in a hierarchical manner. Rather, there is a tendency toward consensus, the inclusion of a number of actors and their participation in decision making. This is the result of the political culture but also of the electoral laws and election results. The health care sector is characterized by interdependence between public institutions and private providers of public service. It must be added that political parties play a fairly important role in health care management via local and regional hospitals. Therefore, partisan political negotiation and commitment to the sector are unavoidable, leading to a form of corporate management based on agreements.


This way of conducting politics and the organization of the sector itself explain why the economic approach has been that of cost control, payments based on standardized services, and the improvement of efficiency at the expense of other approaches of greater interest to professionals or citizens, such as clinical effectiveness, quality, or equality.  It also explains the difficulties involved in the endeavor to improve information on Catalan health care outcomes, principally with the report on Catalan health care entitled “Central de Resultats”.  Since it is difficult to achieve acceptance of reforms that must be negotiated and renegotiated in this sector, the most likely result was the slow development of this instrument, as it was. In fact, the “Central de Resultats” report that was begun the first year of the tripartite government was published in 2010, just before the elections without any publicity and with aggregate data for all Catalonia. That is, without data on individual hospitals and primary care centers as is done in other countries discussed in the book.


Book can be legally downloaded, in Catalan or Spanish, from the web of Escola d’Administració Pública de Catalunya/Publicacions/Col·lecció Estudis Digitals.