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Dublin: 20°C Wednesday 4 August 2021

Column: Why league tables for doctors – but not schools?

School “league tables” are not allowed in Ireland, meaning you can’t find out how schools do in national exams or standardised tests. But creating such tables is not as difficult as we are led to believe, writes Kevin Denny.

Kevin Denny

IT WAS ANNOUNCED yesterday that the Minister for Health is proposing to publish online details of mortality and morbidity rates as well as waiting list data for medical consultants. According to an article published in the Irish Independent, Dr Reilly said: “I think you’re entitled to know [this information], I really believe this… It’s a performance curve that helps everybody, that lifts all boats.”

That is interesting for a number of reasons. I don’t know if this is a new proposal or whether there is a policy document supporting this or whether there has been a consultation process. One would hope that a policy such as this is not just based on the Minister’s beliefs. I can’t find anything on the Department of Health’s website but I may have missed it.

I think this contrasts very strongly with the policy in education. As you may know school “league tables” are not allowed here. You cannot find out how schools do in national exams or standardised tests. There is no question of getting data on individual teachers. From what I can see the educational establishment in general is pretty much against school performance data despite parents being overwhelmingly in favour: the Department of Education surveyed parents on the subject a few years ago. My thoughts are here. See here also for some OECD observations on the policy.

Not comparing like with like

One of the major criticisms of publishing school performance data is that you are not comparing like with like. Different schools may have very different student bodies to educate so the raw exam data would not reflect the performance of the school. There is some merit in this argument. Essentially it is saying that you can’t measure productivity by gross output, you need a measure of value added. Fair enough.

It doesn’t seem to have occurred to the critics that it is possible, to some extent, to address this concerns.

These issues are not unique to Ireland and there is a big bunch of people out there, we call them statisticians, who are adept at helping us collect, present and interpret data. A useful set of articles was published here recently. It is also worth remembering that while there may be costs to publishing the data, there also costs to not doing so.

Raw data doesn’t reflect variables

Anyway, it should be clear that exactly the same issue arises with publishing mortality and morbidity data for medical consultants. The raw data won’t reflect the differences in the sort of patients, the case-mix, that doctors treat. Some patients are older than others. Some are sicker than others. This will influence how they do fare during and after their treatment. A doctor who is willing to take on difficult cases may have had worse mortality rates than more risk-averse doctors. Publishing this data could change the incentives for doctors to take on more challenging cases.

I presume that it is also the case that mortality and morbidity figures will depend on other factors such as treatment facilities, after-care and the team that the doctor works with- factors that may be beyond their control.

This is why there has been huge controversy in the UK as the National Health Service has rolled out the publication of such data. I don’t know enough to say whether it is possible to produce value added data in this context that is meaningful. I suspect  it is easier to do for education as you can have repeat observations on schools and students.

The inconsistency of government policy

What strikes me overall is the inconsistency of government policy. Why follow such a policy in one area like health and not another, like education, when exactly the same objections can be raised? Would it not be better to coordinate policy-making here by assembling experts with in-depth knowledge of the specific areas, as well as in the common statistical and technical issues, so they can learn from each other and produce a general approach to this problem but tailored to their specific domains of health and education?

Moreover the public and the professionals concerned are more likely to buy in these systems when they know they have been well thought-through and are part of a consistent government policy and not ad hoc policy choices.

It’s time for some joined-up policy making.

Dr Kevin Denny was educated at University College Dublin and Oxford University. He is a senior lecturer in Economics at UCD and a research fellow at the Geary Institute. His research and teaching interests include the labour market, education, and behavioural economics. He blogs at Kevin Denny: Economics more-or-less.

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