Arguments in Support of Consumer Reporting

Advocates of public reporting offer several arguments in support of this strategy:

People do want and use comparative information.

The criticisms of public reporting ignore the evidence that people would like more objective information to support their health care-related decisions. The Kaiser Family Foundation’s 2008 Update on Consumers’ Views of Patient Safety and Quality Information found a consistent upward trend since 1996 in the percentage of people who said they would prefer a highly rated health plan or provider to one recommended by friends.[1] This finding is supported by research with consumers who are asked to comment on what they would like to know about providers.[2]

The Kaiser Family Foundation’s survey also indicates that roughly half of those who have seen comparative information use it in some way.[3] While some consumers use the data to choose a different provider, others use it to assure themselves about the choices they have already made.

To the extent that today’s reports are not being used, the answer is not to stop producing reports but to do a better job of giving people the information they want at a time and in a way they can use it. We also need to do a much better job of promoting the information so people know it is available and what to do with it.[4]

Information is empowering.

Information on quality makes consumers aware of what they are really getting and enables them to make decisions that reflect their needs and their values. Nutrition labels, for instance, made people conscious of their consumption in a new way. For the first time, they were able to judge the quality of food based on objective measures, compare products, and make informed decisions about the foods they eat. In the context of health care, information enables consumers to identify coverage, caregivers, and medical practices that best suit their personal needs.

Information separates myth from reality.

Information on quality punctures our fantasies and calms our fears. Thanks to advertising and daily stories in the media, Americans are flooded with opinions and advice about health care with little help in sifting through it to find the nuggets of truth. We lack the solid grounding to make objective judgments about what we’re hearing. Maybe the local hospital is better than the academic medical center downtown. Maybe the care from one medical practice is better than the care available at others. Without objective information, we simply don’t know.

Information influences people to change behavior.

While information alone is not always sufficient, it can affect the decisions that people make. For example, information on the quality of our environment—such as reports on air quality and power lines—helps people make judgments about where to live and what kinds of transportation to use.

It is not yet clear whether health care report cards will drive changes in consumer behavior that actually affect the health care system, but the true test of their impact cannot occur until a sufficient number of consumers become aware of the gaps in quality, have access to good information, and are equipped to apply the information to make choices.

Information drives organizations to change behavior.

Information also creates pressure for the producers of goods and services to change. Food manufacturers, for instance, introduced new lines of low-fat and low-carbohydrate products after consumers became aware of the nutritional content of existing products. Information on the quality of cars and trucks has reshaped the entire industry’s approach to designing, manufacturing, and selling vehicles.

Consumer reports give health care providers and plans benchmarks, performance targets, and a focus for their quality improvement efforts. And there is evidence that health care organizations do take steps to improve their care when their performance is being reported to the public. Whether or not consumers change their behavior, the bright light of public information has brought about changes in the practices and policies of many health plans, hospitals, and medical groups —including some that had years of access to similar comparative information that was not publicly available.[5][6]

Research also indicates that public reports encourage employers and other purchasers to make decisions and implement programs (e.g., pay-for-performance) that favor higher-quality plans and providers.[7]

It’s still early.

Finally, criticisms of public reporting reflect the current state of report cards, which are still in the early stages of development. Supporters of this strategy envision that the art and science of reporting will evolve to address the concerns that critics raise. The TalkingQuality Web site was designed to facilitate that evolution by helping current and potential sponsors of report cards better understand how to produce valid, understandable, and usable reports.

[1] Kaiser Family Foundation. 2008 Update on Consumers' Views of Patient Safety and Quality Information. 2008 October 15. Available at http://www.kff.org/kaiserpolls/posr101508pkg.cfm.
[2] For example, see: Sofaer S, Crofton C, Goldstein E, Hoy E, Crabb J. What Do Consumers Want to Know about the Quality of Care in Hospitals? Health Serv Res Dec 2005; 40(6 Pt 2): 2018-36.
[3] Kaiser Family Foundation. 2008 Update on Consumers' Views of Patient Safety and Quality Information. 2008 October 15. Available at http://www.kff.org/kaiserpolls/posr101508pkg.cfm.
[4] See: Shaller DV, Sofaer S, Findlay S, Hibbard JH, Lansky D, Delbanco S. Consumers and quality-driven health care: a call to action. Health Aff 2003; 22(2):95-101.
[5] Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood). 2003 Mar-Apr;22(2):84-94.
[6] Laschober M, Maxfield M, Felt-Lisk S, Miranda DJ. Hospital response to public reporting of quality indicators. Health Care Finance Rev 2007 Spring;28(3):61-76.
[7] Chernew M, Gowrisankaran G, McLaughlin C, Gibson T. Quality and employers’ choice of health plans. J Health Econ May 2004. 23:471-92.

Also in "Make the Case for Consumer Reporting"

Page last reviewed July 2011
Page originally created February 2015
Internet Citation: Arguments in Support of Consumer Reporting. Content last reviewed July 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/tools/arg2.html