What Can We Say about the Impact of Public Reporting? Inconsistent Execution Yields Variable Results

Improving the quality of care is a high priority for those who pay for and regulate health care. Yet, policymakers have a limited number of levers for encouraging efforts to improve quality. The most frequently used approach is to measure and report health care performance. The theory is that making information on performance publicly available will motivate practitioners, plans, and hospitals to improve in order to protect or expand their market share. Thus, the policy approach relies largely on consumers' attention to and use of information about quality of care. The underlying assumption is that consumers will want and use information about comparative performance. Experience to date, however, does not support this assumption. Consumers have been slow to take an interest in these comparative reports and to use them in choosing a physician, health plan, or hospital. Considerable resources go into the measurement of performance and public reporting. To what degree is the investment achieving its intended outcomes?

In this issue, Fung and colleagues (1) help to answer this question in their systematic review of research on the impact of public reports on quality improvement. They synthesize the evidence from 45 studies published since 1986 and assess the impact of public reporting on consumer decisions, quality improvement efforts, and improved effectiveness. They examined reports at the health plan, hospital, and provider levels. They found that public reporting of hospital performance seems to stimulate hospitals to make efforts to improve quality but has only a moderate impact on consumers' selection of a health …