Skip to main content
Quality in Health Care : QHC logoLink to Quality in Health Care : QHC
. 2001 Jun;10(2):96–103. doi: 10.1136/qhc.10.2.96

Publicly disclosed information about the quality of health care: response of the US public

E Schneider 1, T Lieberman 1
PMCID: PMC1757976  PMID: 11389318

Abstract

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care.

Key Words: public disclosure; quality of health care; quality improvement

Full Text

The Full Text of this article is available as a PDF (125.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bentley J. M., Nash D. B. How Pennsylvania hospitals have responded to publicly released reports on coronary artery bypass graft surgery. Jt Comm J Qual Improv. 1998 Jan;24(1):40–49. doi: 10.1016/s1070-3241(16)30358-3. [DOI] [PubMed] [Google Scholar]
  2. Bodenheimer T. The American health care system--physicians and the changing medical marketplace. N Engl J Med. 1999 Feb 18;340(7):584–588. doi: 10.1056/NEJM199902183400725. [DOI] [PubMed] [Google Scholar]
  3. Bodenheimer T. The American health care system--the movement for improved quality in health care. N Engl J Med. 1999 Feb 11;340(6):488–492. doi: 10.1056/NEJM199902113400621. [DOI] [PubMed] [Google Scholar]
  4. Carman K. L., Short P. F., Farley D. O., Schnaier J. A., Elliott D. B., Gallagher P. M. Epilogue: Early lessons from CAHPS Demonstrations and Evaluations. Consumer Assessment of Health Plans Study. Med Care. 1999 Mar;37(3 Suppl):MS97–M105. [PubMed] [Google Scholar]
  5. Chassin M. R., Galvin R. W. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998 Sep 16;280(11):1000–1005. doi: 10.1001/jama.280.11.1000. [DOI] [PubMed] [Google Scholar]
  6. Chernew M., Scanlon D. P. Health plan report cards and insurance choice. Inquiry. 1998 Spring;35(1):9–22. [PubMed] [Google Scholar]
  7. Christianson J., Feldman R., Weiner J. P., Drury P. Early experience with a new model of employer group purchasing in Minnesota. Health Aff (Millwood) 1999 Nov-Dec;18(6):100–114. doi: 10.1377/hlthaff.18.6.100. [DOI] [PubMed] [Google Scholar]
  8. Dziuban S. W., Jr, McIlduff J. B., Miller S. J., Dal Col R. H. How a New York cardiac surgery program uses outcomes data. Ann Thorac Surg. 1994 Dec;58(6):1871–1876. doi: 10.1016/0003-4975(94)91730-2. [DOI] [PubMed] [Google Scholar]
  9. Edgman-Levitan S., Cleary P. D. What information do consumers want and need? Health Aff (Millwood) 1996 Winter;15(4):42–56. doi: 10.1377/hlthaff.15.4.42. [DOI] [PubMed] [Google Scholar]
  10. Enthoven A. C. Multiple choice health insurance: the lessons and challenge to employers. Inquiry. 1990 Winter;27(4):368–373. [PubMed] [Google Scholar]
  11. Enthoven A. C. The history and principles of managed competition. Health Aff (Millwood) 1993;12 (Suppl):24–48. doi: 10.1377/hlthaff.12.suppl_1.24. [DOI] [PubMed] [Google Scholar]
  12. Epstein A. M. Rolling down the runway: the challenges ahead for quality report cards. JAMA. 1998 Jun 3;279(21):1691–1696. doi: 10.1001/jama.279.21.1691. [DOI] [PubMed] [Google Scholar]
  13. Epstein A. Performance reports on quality--prototypes, problems, and prospects. N Engl J Med. 1995 Jul 6;333(1):57–61. doi: 10.1056/NEJM199507063330114. [DOI] [PubMed] [Google Scholar]
  14. Erickson L. C., Torchiana D. F., Schneider E. C., Newburger J. W., Hannan E. L. The relationship between managed care insurance and use of lower-mortality hospitals for CABG surgery. JAMA. 2000 Apr 19;283(15):1976–1982. doi: 10.1001/jama.283.15.1976. [DOI] [PubMed] [Google Scholar]
  15. Gawande A. A., Blendon R., Brodie M., Benson J. M., Levitt L., Hugick L. Does dissatisfaction with health plans stem from having no choices? Health Aff (Millwood) 1998 Sep-Oct;17(5):184–194. doi: 10.1377/hlthaff.17.5.184. [DOI] [PubMed] [Google Scholar]
  16. Ghali W. A., Ash A. S., Hall R. E., Moskowitz M. A. Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA. 1997 Feb 5;277(5):379–382. [PubMed] [Google Scholar]
  17. Green J., Wintfeld N. Report cards on cardiac surgeons. Assessing New York State's approach. N Engl J Med. 1995 May 4;332(18):1229–1232. doi: 10.1056/NEJM199505043321812. [DOI] [PubMed] [Google Scholar]
  18. Greene J. Report cards. Cleveland's Phoenix. Hosp Health Netw. 1999 Jul;73(7):14–16. [PubMed] [Google Scholar]
  19. Grumbach K., Osmond D., Vranizan K., Jaffe D., Bindman A. B. Primary care physicians' experience of financial incentives in managed-care systems. N Engl J Med. 1998 Nov 19;339(21):1516–1521. doi: 10.1056/NEJM199811193392106. [DOI] [PubMed] [Google Scholar]
  20. Hannan E. L., Kilburn H., Jr, Racz M., Shields E., Chassin M. R. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994 Mar 9;271(10):761–766. [PubMed] [Google Scholar]
  21. Hibbard J. H., Jewett J. J., Engelmann S., Tusler M. Can Medicare beneficiaries make informed choices? Health Aff (Millwood) 1998 Nov-Dec;17(6):181–193. doi: 10.1377/hlthaff.17.6.181. [DOI] [PubMed] [Google Scholar]
  22. Hibbard J. H., Jewett J. J. What type of quality information do consumers want in a health care report card? Med Care Res Rev. 1996 Mar;53(1):28–47. doi: 10.1177/107755879605300102. [DOI] [PubMed] [Google Scholar]
  23. Hibbard J. H., Slovic P., Jewett J. J. Informing consumer decisions in health care: implications from decision-making research. Milbank Q. 1997;75(3):395–414. doi: 10.1111/1468-0009.00061. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Jencks S. F., Cuerdon T., Burwen D. R., Fleming B., Houck P. M., Kussmaul A. E., Nilasena D. S., Ordin D. L., Arday D. R. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. JAMA. 2000 Oct 4;284(13):1670–1676. doi: 10.1001/jama.284.13.1670. [DOI] [PubMed] [Google Scholar]
  25. Kassirer J. P. The quality of care and the quality of measuring it. N Engl J Med. 1993 Oct 21;329(17):1263–1265. doi: 10.1056/NEJM199310213291710. [DOI] [PubMed] [Google Scholar]
  26. Kerr E. A., Mittman B. S., Hays R. D., Leake B., Brook R. H. Quality assurance in capitated physician groups. Where is the emphasis? JAMA. 1996 Oct 16;276(15):1236–1239. [PubMed] [Google Scholar]
  27. Knutson D. Case study: the Minneapolis Buyers Health Care Action Group. Inquiry. 1998 Summer;35(2):171–177. [PubMed] [Google Scholar]
  28. Legnini M. W., Rosenberg L. E., Perry M. J., Robertson N. J. Where does performance measurement go from here? Health Aff (Millwood) 2000 May-Jun;19(3):173–177. doi: 10.1377/hlthaff.19.3.173. [DOI] [PubMed] [Google Scholar]
  29. Lieberman T. How does your HMO stack up? 19,000 readers help us judge 54 health plans. Consum Rep. 1999 Aug;64(8):23–29. [PubMed] [Google Scholar]
  30. Lo Sasso A. T., Perloff L., Schield J., Murphy J. J., Mortimer J. D., Budetti P. P. Beyond cost: 'responsible purchasing' of managed care by employers. Health Aff (Millwood) 1999 Nov-Dec;18(6):212–223. doi: 10.1377/hlthaff.18.6.212. [DOI] [PubMed] [Google Scholar]
  31. Long S. H., Marquis M. S. Pooled purchasing: who are the players? Health Aff (Millwood) 1999 Jul-Aug;18(4):105–111. doi: 10.1377/hlthaff.18.4.105. [DOI] [PubMed] [Google Scholar]
  32. Longo D. R., Land G., Schramm W., Fraas J., Hoskins B., Howell V. Consumer reports in health care. Do they make a difference in patient care? JAMA. 1997 Nov 19;278(19):1579–1584. [PubMed] [Google Scholar]
  33. Luft H. S., Garnick D. W., Mark D. H., Peltzman D. J., Phibbs C. S., Lichtenberg E., McPhee S. J. Does quality influence choice of hospital? JAMA. 1990 Jun 6;263(21):2899–2906. [PubMed] [Google Scholar]
  34. Marshall M. N., Shekelle P. G., Leatherman S., Brook R. H. Public disclosure of performance data: learning from the US experience. Qual Health Care. 2000 Mar;9(1):53–57. doi: 10.1136/qhc.9.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Marshall M. N., Shekelle P. G., Leatherman S., Brook R. H. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA. 2000 Apr 12;283(14):1866–1874. doi: 10.1001/jama.283.14.1866. [DOI] [PubMed] [Google Scholar]
  36. Maxwell J., Briscoe F., Davidson S., Eisen L., Robbins M., Temin P., Young C. Managed competition in practice: 'value purchasing' by fourteen employers. Health Aff (Millwood) 1998 May-Jun;17(3):216–226. doi: 10.1377/hlthaff.17.3.216. [DOI] [PubMed] [Google Scholar]
  37. McGee J., Kanouse D. E., Sofaer S., Hargraves J. L., Hoy E., Kleimann S. Making survey results easy to report to consumers: how reporting needs guided survey design in CAHPS. Consumer Assessment of Health Plans Study. Med Care. 1999 Mar;37(3 Suppl):MS32–MS40. doi: 10.1097/00005650-199903001-00004. [DOI] [PubMed] [Google Scholar]
  38. McGlynn E. A. Six challenges in measuring the quality of health care. Health Aff (Millwood) 1997 May-Jun;16(3):7–21. doi: 10.1377/hlthaff.16.3.7. [DOI] [PubMed] [Google Scholar]
  39. McNeil B. J., Pedersen S. H., Gatsonis C. Current issues in profiling quality of care. Inquiry. 1992 Fall;29(3):298–307. [PubMed] [Google Scholar]
  40. Mennemeyer S. T., Morrisey M. A., Howard L. Z. Death and reputation: how consumers acted upon HCFA mortality information. Inquiry. 1997 Summer;34(2):117–128. [PubMed] [Google Scholar]
  41. Miller T., Leatherman S. The National Quality Forum: a 'me-too' or a breakthrough in quality measurement and reporting? Health Aff (Millwood) 1999 Nov-Dec;18(6):233–237. doi: 10.1377/hlthaff.18.6.233. [DOI] [PubMed] [Google Scholar]
  42. Mukamel D. B., Mushlin A. I. Quality of care information makes a difference: an analysis of market share and price changes after publication of the New York State Cardiac Surgery Mortality Reports. Med Care. 1998 Jul;36(7):945–954. doi: 10.1097/00005650-199807000-00002. [DOI] [PubMed] [Google Scholar]
  43. Mukamel D. B., Mushlin A. I., Weimer D., Zwanziger J., Parker T., Indridason I. Do quality report cards play a role in HMOs' contracting practices? Evidence from New York State. Health Serv Res. 2000 Apr;35(1 Pt 2):319–332. [PMC free article] [PubMed] [Google Scholar]
  44. O'Connor G. T., Plume S. K., Olmstead E. M., Morton J. R., Maloney C. T., Nugent W. C., Hernandez F., Jr, Clough R., Leavitt B. J., Coffin L. H. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. JAMA. 1996 Mar 20;275(11):841–846. [PubMed] [Google Scholar]
  45. Peterson E. D., DeLong E. R., Jollis J. G., Muhlbaier L. H., Mark D. B. The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly. J Am Coll Cardiol. 1998 Oct;32(4):993–999. doi: 10.1016/s0735-1097(98)00332-5. [DOI] [PubMed] [Google Scholar]
  46. Robinson J. C., Gardner L. B. Adverse selection among multiple competing health maintenance organizations. Med Care. 1995 Dec;33(12):1161–1175. doi: 10.1097/00005650-199512000-00001. [DOI] [PubMed] [Google Scholar]
  47. Robinson S., Brodie M. Understanding the quality challenge for health consumers: the Kaiser/AHCPR Survey. Jt Comm J Qual Improv. 1997 May;23(5):239–244. doi: 10.1016/s1070-3241(16)30313-3. [DOI] [PubMed] [Google Scholar]
  48. Rosenthal G. E., Hammar P. J., Way L. E., Shipley S. A., Doner D., Wojtala B., Miller J., Harper D. L. Using hospital performance data in quality improvement: the Cleveland Health Quality Choice experience. Jt Comm J Qual Improv. 1998 Jul;24(7):347–360. doi: 10.1016/s1070-3241(16)30386-8. [DOI] [PubMed] [Google Scholar]
  49. Rosenthal G. E., Quinn L., Harper D. L. Declines in hospital mortality associated with a regional initiative to measure hospital performance. Am J Med Qual. 1997 Summer;12(2):103–112. doi: 10.1177/0885713X9701200204. [DOI] [PubMed] [Google Scholar]
  50. Scanlon D. P., Chernew M. HEDIS measures and managed care enrollment. Med Care Res Rev. 1999;56 (Suppl 2):60–84. [PubMed] [Google Scholar]
  51. Schauffler H. H., Brown C., Milstein A. Raising the bar: the use of performance guarantees by the Pacific Business Group on Health. Health Aff (Millwood) 1999 Mar-Apr;18(2):134–142. doi: 10.1377/hlthaff.18.2.134. [DOI] [PubMed] [Google Scholar]
  52. Schneider E. C., Epstein A. M. Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. N Engl J Med. 1996 Jul 25;335(4):251–256. doi: 10.1056/NEJM199607253350406. [DOI] [PubMed] [Google Scholar]
  53. Schneider E. C., Epstein A. M. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998 May 27;279(20):1638–1642. doi: 10.1001/jama.279.20.1638. [DOI] [PubMed] [Google Scholar]
  54. Schneider E. C., Riehl V., Courte-Wienecke S., Eddy D. M., Sennett C. Enhancing performance measurement: NCQA's road map for a health information framework. National Committee for Quality Assurance. JAMA. 1999 Sep 22;282(12):1184–1190. doi: 10.1001/jama.282.12.1184. [DOI] [PubMed] [Google Scholar]
  55. Spranca M., Kanouse D. E., Elliott M., Short P. F., Farley D. O., Hays R. D. Do consumer reports of health plan quality affect health plan selection? Health Serv Res. 2000 Dec;35(5 Pt 1):933–947. [PMC free article] [PubMed] [Google Scholar]
  56. Vladeck B. C., Goodwin E. J., Myers L. P., Sinisi M. Consumers and hospital use: the HCFA "death list". Health Aff (Millwood) 1988 Spring;7(1):122–125. doi: 10.1377/hlthaff.7.1.122. [DOI] [PubMed] [Google Scholar]
  57. Zaslavsky A. M., Landon B. E., Beaulieu N. D., Cleary P. D. How consumer assessments of managed care vary within and among markets. Inquiry. 2000 Summer;37(2):146–161. [PubMed] [Google Scholar]

Articles from Quality in Health Care : QHC are provided here courtesy of BMJ Publishing Group

RESOURCES