The Tyranny of Metrics

by Jerry Z. Muller

9. Remember that even the best measures are subject to corruption or goal diversion. Insofar as individuals are agents out to maximize their own interests, there are inevitable drawbacks to all schemes of measured reward. If, as is currently still the case, doctors are remunerated based on the procedures they perform, that creates an incentive for them to perform too many procedures that have high costs but produce low benefits. But pay doctors based on the number of patients they see, and they have an incentive to see as many patients as possible, and to skimp on procedures that are time-consuming but potentially useful. Compensate them based on successful patient outcomes, and they are more likely to cream, avoiding the most problematic patients.5 That doesn’t mean that performance measures should be abandoned just because they have some negative outcomes. Such metrics may still be worth using, despite their anticipatable problems: it’s a matter of trade-offs. And that too is a matter of judgment.