Evidence of the impacts of different models of governance and reporting systems on quality of health care

This paper considers the evidence for improving quality of health care from the design of reporting systems and four different models of governance: altruism (or trust), hierarchy and targets¸ choice and competition and reputation. The evidence from the design of reporting systems is largely from evaluations of report cards in the US, in which information on the quality of care of providers was published, but also includes an evaluation of a Scottish system which pioneered such public reporting in Europe. The evidence of models of governance comes from policies that have been tried in the National Health Services (NHSs) of the four countries of the UK since 1991.