Can performance measurement make health care systems more sustainable? Or at least more efficient?

In light of the many discussions advocating the use of pay-for-performance and performance budgeting, this paper argues that discouraging experience with both approaches should temper expectations that performance measurement can be a reform that will make health care systems more "sustainable" or even more efficient. The link between sustainability and efficiency is tenuous, and attention to performance is not new. Measurement's accuracy tends to be overstated and its costs understated or ignored. Nor does it easily lead to changed behaviour. Yet some measurement is useful for managing any complex activity. In particular, there are situations in which measures are more accurate and the proper responses to shortfalls are generally agreed. Policymakers should look for those conditions and encourage the more limited, targeted improvement that measures then can make possible.