To the Editor: The study of the effectiveness of report cards in cardiac care by Dr Tu and colleagues1 addressed an important issue in health policy: does the public reporting of quality indicators actually improve the performance of hospitals? The well-designed trial effectively demonstrated the disconnect that sometimes exists between the need to improve health care delivery and the willingness or ability of hospitals to actually do so.
This study was conducted in a publicly funded health care system, in which patient or payer preference does not usually dictate choice of hospital during medical emergencies. Although public reporting in such a system may increase awareness of hospital performance among users, it may not provide hospitals with the requisite market-driven incentives to actually improve performance.
The effectiveness of public reporting on quality measures may differ in the United States,2 - 3 where a majority of health insurance coverage is provided through managed care organizations that contract care to select health care institutions on the basis of high quality-cost ratio.4 These organizations employ incentive payment schemes to shift excess health care costs (eg, those resulting from recurrent admissions) to the hospital. Managed care organizations that offer patients a wide selection of hospitals transfer the responsibility for some costs to the patient, thereby creating a cost- and quality-conscious patient.4 In such a system, report card scores may directly influence market shares and profitability of a hospital, providing the impetus for improvement.5
Another factor that may account for the lack of effectiveness of report cards in improving care was the relatively short interval between public reporting (January 2004) and follow-up performance data (beginning in April 2004). The interval of only a few months may not have been sufficient for the development and implementation of effective strategies to narrow the gap between ideal and actual practice in a system that is not driven by market forces.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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