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Mary E Seddon
In this issue of the Journal Chaudhry et al present the case for New Zealand to "join the ranks of health systems that embrace public reporting of quality data in the spirit of full and open transparency, benchmarking and continual improvement."1 A fine aim, but is it as simple as following the US and UK lead, and will it improve healthcare services?
An early report out of the RAND2 made the point that the "US experience of public disclosure is presented in the context of its healthcare system and consumer orientated culture." It is important to bear in mind some of the key differences in the US compared with New Zealand: patient and doctor autonomy is highly valued and there is at least theoretical choice of hospital (mostly controlled by employers as health insurers); hospitals exist in competitive markets; and due to their billing databases they have better quality and granularity of data (this comes at a cost with administration greater than 20% of the total spend on health, five times the OECD average).3,4
The UK healthcare system is more similar to New Zealand's, however with primary care commissioning there is also choice of hospital/services. In the New Zealand public health system, patients do not have a choice as to which hospital to attend, therefore the publication of hospital performance data may not be a competitive driver for improvement. So to answer the first question, it appears unwise to simply transfer performance indicators from other countries (tempting though it is).5
Public disclosure of healthcare performance data (predominantly hospital or provider performance) has been advocated for two main reasons:
* Accountability/transparency
* As a driver for quality improvement
To review these in turn. It seems that there is a policy appetite in developed countries for transparency and some form of accountability. Although it is stated in terms of accountability to the public, most studies show that the 'public' do not search out performance reports, often do not understand them if they do, and make little use of them in their decisions as to where to seek healthcare.6-8
When there is a choice of hospital or doctor, the evidence suggests that the advice of friends and family,9 the long-term relationship with a doctor10 and...
