Source: The New York Times

Was the treatment successful (effective)?  Was is economical (efficient)? 

Princeton economics professor Uwe Reinhardt outlines the challenges of answering these questions--and constructing a marketplace that measures and rewards successful outcomes--in the health care field, but could have as easily been discussing the social sector:

An accusation frequently lobbed against Medicare is that it pays providers of health care for services regardless of the quality of these services, or even their appropriateness.

In fairness, however, that accusation can be made against all third-party payers for health care, both private and public, in the United States and abroad.

Like health insurance companies, foundations, governments, and other grantmakers are third-party payers of often-complex services -- and assessing performance can be difficult.  But understanding what makes this difficult is key to developing systemic solutions.