by Mirella Cacace
Public reporting in health denotes the disclosure of comparative information about the performance of providers to the general public. Expected benefits of this strategy are to promote transparency and informed choice, to stimulate quality improvement, and to hold providers accountable for the care they deliver. Since its inception in the US-Medicare programme, many European nations have invested in public reporting to improve quality in service delivery. A core question policy makers face today is how to shape public reporting systems in order to achieve these benefits while minimising associated risks.
Involving the patient
In modern societies, transparency and the availability of information are regarded as values in their own right. In this vein, public reporting is one instrument to endow patients with knowledge and to gear healthcare systems towards greater patient orientation. Furthermore, quality information enables patients to engage in a more self-conscious and better informed dialogue with the provider. The knowledge about providers’ performance finally empowers the users to exercise informed choice and to select providers according to quality criteria.
A major obstacle for the efficiency of public reporting systems is that users do not frequently use the available information for decision making. Notoriously, family and friends are the primary source when it comes to the choice of provider. At the same time, consumers require more information on the quality of services, preferably from independent sources. In order to increase utilization, the sponsors of these systems must make patients aware of the reports, enable them to interpret the information correctly, create trust in the information, and make sure that this information is relevant for decision making. Consequentially, continuous research and adaptation to the users’ expectations and needs is required. In addition, there is a role for patient advocacy groups and support organisations to assist consumers in interpreting performance data.
Another core challenge for the designers of such systems is to transmit a wealth of information in a usable format. Here interactive media and the internet offer wide technical opportunities. At the same time, disparities in the access to the World Wide Web exist, disadvantaging particularly those in greater need of care. If public reporting allows better informed groups to receive higher quality care, policy makers need to ensure that everybody has access to this information and a fair chance to belong to that group.
Changing provider behaviour
When evaluating the effectiveness of public reporting, we need to consider another major target group for publicly disclosed information, i.e. the providers themselves. Comparative information allows service providers to identify areas of underperformance relative to their peers. Due to the threat of reputational damage, the public reporting provides a strong incentive to improve on quality. However, quality measurement and reporting also give way for gaming, such as delivering poor performance in domains where performance is not measured, ambiguity in reporting of data, or outright fabrication. Wherever risk-adjustment is absent or incomplete, the mechanism encourages favourable selection.
In order to benefit from public reporting through providers’ behaviour change, indicators need to be developed further according to scientific standards. Indicators need to be valid, sensible to change, reliable, consistent, and must not be prone to manipulation. In addition, financial incentives (pay for reporting/pay for transparency) and last not least government involvement can be beneficial, in particular in achieving the comprehensiveness of comparative data.
In sum, there are several pathways how quality measurement and public reporting can lead to better performance of healthcare systems. To harvest these benefits, public reporting initiatives need to be constantly refined and adapted to the users’ needs. There finally is also a role for third parties, such as patient advocacy groups and regulators, in order to reduce potential shortcomings.
Mirella Cacace is a visiting professor for Regional Health Economics at Leuphana University in Lüneburg, Germany.
This post follows a seminar from Professor Cacace at LSE on 9 May 2012 on public reporting on the quality of healthcare providers: international experience and prospects as part of the LSEHSC Formal Seminar Series.
Cacace M, Ettelt S, Brereton L, Pedersen J, Nolte E (2010) How Health Systems Make Available Information on Service Providers: Experience in Seven Countries, RAND Europe and London School of Hygiene & Tropical Medicine.
Cacace M, Geraedts M (2013) Chapter II 10: Public reporting, in Busse R, Klazinga N, Røttingen JA, Velasco Garrido M (eds) Improving Quality in European Health Systems – A Comprehensive Framework, European Observatory for Health Systems and Policies.