Crouch’s thesis is that the financialisation of public institutions reduces the meaning of what they do to a limited number of numerical targets and performance indicators often of a financial kind. This has the effect of also reducing the spectrum of knowledge we need fully to be employees, citizens and customers and constrains expert judgement. It has the effect of trumping all other valuations of particular organizational or social problems with one supposed truth, that of the bottom line or a financial target.
One example he gives of the consequences of financialization from the UK is the monetary incentive offered to GPs to refer more patients with suspected Alzheimer’s disease for further medical tests. The incentive is problematic on a number of fronts: although it is offered on the basis of encouraging behaviour which politicians deem to beneficial to the public as a whole, it nonetheless implies that GPs would not refer patients without such a financial reward. It enacts a theory of motivation at odds with the medical profession’s own values: the overwhelming majority of doctors would not consider it either necessary or desirable to be offered money to refer someone for tests who needs them. Additionally, in Crouch’s terms it has the potential for corrupting expert knowledge as well as creating perverse incentives. Crouch is not implying that professionals need no scrutiny or don’t need managing, but he does argue that financial targets, and numerical targets more generally, are a crude measure of what is really important in specific situations when the work is complex. It is a very crude, mistrustful intervention to bring about a greater focus on potential Alzheimer’s sufferers. Continue reading