Insurance, precisely. Insurance companies are pushing for performance assessment to put pressure on prices. All well and good until you understand that you can'

Insurance, precisely. Insurance companies are pushing for performance assessment to put pressure on prices. All well and good until you understand that you can't force hospitals/practitioners to all get a random sample of patients. So measurements are biased, and therefore people game the system. In practice, it means all healthcare providers will concentrate on easy cases to lower risk and maximize revenue. So as you see, free market thought doesn't really work in healthcare.