Target practice: Are targets more appropriate for some health policy problems than for others, and if so, why?

Abstract

Over the last decade there has been considerable debate about the merits of targets as a policy instrument – much of it fuelled by reflections on their use in England’s National Health Service in the early 2000s. We examine the implementation of two health targets that have been cornerstones of New Zealand health policy since 2009 - immunisation rates for two-year olds, and time to treatment in hospital emergency departments. Our research reveals quite different responses and consequences of the two targets. One has clearly stimulated the positive transformation of a health service and largely solved what had been a persistent policy problem. The other has generated a complex cocktail of positive and negative experiences, behaviours and consequences. In the final part of the paper we examine possible reasons for these divergent stories of ‘target practice’. We argue that the specific characteristics of the policy problem and service area matter, and identify three possible lenses for understanding why these experiences differ (i) the nature of the policy problem (ii) the appropriateness of each target; (iii) the implementation context.