Healthcare providers respond to public reporting

Yet we know little about its effects on performance. However, a recent Health Foundation report indicates that publicly reporting service performance has greatest impact on providers' public image and reputation and does not significantly alter patient choice.

The report Does Public Release of Performance Results Improve Quality of Care?, published by Paul Shekelle and colleagues from the RAND think tank, focuses on studies of patient choice, quality improvement behaviours, safety and effectiveness and patient centred care. It references the key peer-reviewed studies. Most are US studies but still provide rich insights for the UK.

The research shows public reporting stimulates hospital change, particularly where performance is poorest.

Should reporting be mandatory? A 2001 report concluded that health plans that publish performance voluntarily outperform those that do not. Low scoring plans are also more likely to stop publicly disclosing data. So there will be strong bias in systems without mandatory reporting.

Patient benefits

The evidence on benefits for patients is scant, with studies mainly focusing on mortality and cardiac procedures. A 2005 report found that hospitals with low scores in obstetrics adverse events (including complications and death) were more likely to improve with public as opposed to private or no reports (see first chart). But caution is required. Public reporting may generate greater disparity between racial groups and surgeons may be less willing to operate on high-risk patients.

Are changes driven by consumers or by organisations and providers? One study found that those who pick the top performing hospitals or surgeons in New York "have half the chance of dying" than those from the bottom quartile - yet performance did not change market share. But a marked number of surgeons chose to retire or leave the practice following poor results (see second chart). Another study found improvements in performance but not on market share. Public image and reputation of providers were more important.

The RAND report suggests that the design and implementation of reporting systems present a significant challenge. The UK needs to ensure professionals and providers are closely involved in the development of reporting systems. It is also important that the design of public information meets the needs of patients and the public.