How Citizens Respond to Outputs, Outcomes, and Costs: A Survey Experiment About an HIV/AIDS Program

Government performance measurement is often faulted for focusing on outputs, while citizens are said to demand more information on outcomes to hold government accountable. To compare the influence of these measures, we randomized 774 participants to receive outcome or output information about a real HIV prevention program, with or without cost information, in a survey experiment. Citizens expressed less support for spending on the program when shown outcomes (infections prevented), rather than outputs (people served). Showing participants the high cost of treating HIV/AIDS boosted support for program spending, but did not make outcome information more persuasive. We interpret these results as partly a reaction to the high per-unit cost of an outcome in an HIV prevention program. But it may reflect a tendency of citizens simply to misinterpret less costly outputs, including serving more people, as if these were outcomes. This bias has implications for performance reporting and accountability.