Arguments Against Consumer Reporting

While the idea of health care report cards is no longer new, the theory that the dissemination of comparative information will drive changes in the health care system remains controversial.[1] Critics of consumer reporting typically make one or more of the following points.

People do not use the information when they have it.

One of the most damning cases against report cards is evidence that people are not using them to make decisions.[2-5] In addition, surveys have found that quality ratings have little influence on health plan choices.[6] Other studies suggest that patients are not using available data to choose hospitals or surgeons.[7]

One critical barrier to interest and use of quality reports is that most consumers are unaware of the significant gaps in quality. This suggests that the reports alone are not sufficient; a public education campaign may be needed to raise awareness and make the reports meaningful to consumers.

Pressure from consumers won’t be powerful enough to reform the system.

While most people agree that the health care system is in need of reform, the merits of a market-oriented approach to reform are disputed. Data showing limited use of current report cards offer ammunition to those who argue that a strategy built around consumers is not sufficient to change the system.

Quality data can be deceptive and misleading.

Organizations whose performance is being reported often express concern that the information will not accurately reflect how well they provide health care services. They point to real and imagined flaws in the source of the data (whether administrative records, medical charts, or surveys), the methodology for analyzing the data and adjusting it for case mix, the ways in which scores are calculated, and the reporting strategy. If the information is not valid and reliable, users may make poor decisions—possibly worse than they would in the absence of information.

A related issue is that quality measures are inherently limited in their ability to capture either the overall quality of care provided by an entity or the quality of the services that an enrollee or patient is likely to receive. For example, a set of measures related to a hospital’s care of patients with heart disease does not represent what a patient can expect in other departments of the hospital.

Quality data are too complicated for consumers to understand and use.

While this argument is not as common as it used to be, critics still contend that information on quality is too complex and nuanced for people to use effectively. For providers, it has been particularly difficult to select clinical measures that are both representative of the quality of care and easy for people to comprehend and factor into their decisions. The need to identify salient and usable measures is one of the forces behind the ongoing drive for standardization in publicly reported quality indicators.

Reports on quality have unintended consequences.

Some critics argue that the negative impact of public reporting may outweigh any benefits, particularly given how hard it has been to assess the benefits. Unintended consequences include changes in the behavior of physicians, who may avoid sicker patients in order to improve their ratings, and pressure to implement practices that may not be ideal for all patients.[8]

[1] See: Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data. What do we expect to gain? A review of the evidence. JAMA 2000; 283: 1866–74.
[2] See: Canadian Health Services Research Foundation. Myth: People use health system report cards to make decisions about their healthcare. 2006 September. Available at http://www.cfhi-fcass.ca/SearchResultsNews/06-09-01/688b46df-525d-4ba9-98ab-7c1c9b1130d0.aspx. Accessed 03/13/15.
[3] Fung CH, Lim Y, Mattke S, Damberg CL, Shekelle PG. Systematic review: The evidence that publishing patient care performance data improves quality of care. Annals of Internal Medicine 2008; 148: 111–123.
[4] Schauffler HH, Mordavsky JK. Consumer reports in health care: do they make a difference? Annu Rev Public Health. 2001; 22: 69-89.
[5] Marshall MN, Shekelle PG, Leatherman S, Brook RH. (2000). The public release of performance data. What do we expect to gain? A review of the evidence. JAMA. 2000 April 12; 283(14): 1866–1874.
[6] Taylor H, Leitman R, eds. Quality ratings have almost no influence on consumers’ choices of hospitals, health plans and physicians. Harris Interactive Health Care News 2002 Oct 11; 2(19): 1-4.
[7] Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA 1998 May 27;279(20):1638-42.
[8] Werner RM, Asch DA. The unintended consequences of public reporting quality information. JAMA 2005 Mar 9;293(10):1239-44.

Also in "Make the Case for Consumer Reporting"

Page last reviewed March 2015
Page originally created February 2015
Internet Citation: Arguments Against Consumer Reporting. Content last reviewed March 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/tools/arg1.html