"Long before it's in the papers"
February 23, 2015


Study: publicizing hospital ratings doesn’t always spur improvement

Feb. 23, 2015
Courtesy of Imperial College London
and World Science staff

A Brit­ish study is lead­ing re­search­ers to ques­tion wheth­er pub­li­ciz­ing rat­ings of hos­pi­tals leads to much, if any im­prove­ment in the job that hos­pi­tals do.

The study ex­am­ines hos­pi­tals that are part of the Na­t­ional Health Serv­ice, the U.K.’s free, taxpayer-funded pub­lic health sys­tem. In 2008, a se­ries of me­dia re­ports named the best and worst matern­ity care cen­ters un­der the sys­tem. 

But the study found that these re­ports did­n’t lead to more wom­en go­ing to the top hos­pi­tals or avoid­ing the low­est, nor to any spe­cial im­prove­ments in pa­tient sat­is­fac­tion lev­els at the worst-rat­ed hos­pi­tals.

Hos­pi­tal rat­ings in the U.K. were born out of good in­ten­tions, said An­tho­ny Laverty from the School of Pub­lic Health at Im­pe­ri­al Col­lege Lon­don, who led the stu­dy.

The Na­t­ional Health Serv­ice along with oth­er health sys­tems “are in­creas­ingly try­ing to pro­vide more in­forma­t­ion about hos­pi­tals’ per­for­mance on the ba­sis that let­ting pa­tients make in­formed choices about where they go for their care will im­prove stan­dards,” he said.

But so far “the ev­i­dence for this is patchy, and mainly comes from car­di­ac sur­gery in the U.S. We wanted to test this idea by look­ing at matern­ity care in Eng­land, since preg­nant wom­en might be more proac­tive in seek­ing in­forma­t­ion and choos­ing in ad­vance where they want to give birth.”

“Our re­sults sug­gest that re­leas­ing in­forma­t­ion on the qual­ity of hos­pi­tals did­n’t mean that wom­en ended up with bet­ter care. Added to oth­er stud­ies, the ev­i­dence sug­gests that pub­lic re­port­ing is un­likely to im­prove the qual­ity of health ser­vic­es through pa­tient choice.”

The U.K.’s Health­care Com­mis­sion re­leased the rat­ings in Jan­u­ary 2008. They came from a sur­vey of 26,000 wom­en as­sess­ing their matern­ity care, and drew wide­spread me­dia cov­er­age both na­t­ionally and in lo­cal mar­kets where hos­pi­tals were rat­ed as do­ing par­tic­u­larly well or bad­ly.

The Im­pe­ri­al re­search­ers com­pared the cen­ters named as best and worst with the oth­ers, ex­clud­ing those with only a small num­ber of matern­ity ad­mis­sions. They looked at the num­ber of matern­ity ad­mis­sions for each cen­ter and sur­vey sat­is­fac­tion lev­els in 2007 and 2010. The results showed no sig­nif­i­cant dif­fer­ence in ad­mis­sions in the three years af­ter the me­dia re­ports.

The re­search is pub­lished in the Jour­nal of Health Serv­ices Re­search & Pol­i­cy.

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A British study is leading researchers to question whether publicizing ratings of hospitals leads to much, if any improvement in the job that hospitals do. The new study examines hospitals that are part of the National Health Service, the U.K.’s free, taxpayer-funded public health system. In 2008, a series of media reports named the best and worst maternity care centers under the system. But the study found that these reports didn’t lead to more women going to the top hospitals or avoiding the lowest, nor to any special improvements in patient satisfaction levels at the worst-rated hospitals. Hospital ratings in the U.K. were born out of good intentions, said Anthony Laverty from the School of Public Health at Imperial College London, who led the study. The National Health Service along with other health systems “are increasingly trying to provide more information about hospitals’ performance on the basis that letting patients make informed choices about where they go for their care will improve standards,” he said. But so far “the evidence for this is patchy, and mainly comes from cardiac surgery in the U.S. We wanted to test this idea by looking at maternity care in England, since pregnant women might be more proactive in seeking information and choosing in advance where they want to give birth.” “Our results suggest that releasing information on the quality of hospitals didn’t mean that women ended up with better care. Added to other studies, the evidence suggests that public reporting is unlikely to improve the quality of health services through patient choice.” The U.K.’s Healthcare Commission released the ratings in January 2008. They came from a survey of 26,000 women assessing their maternity care, and drew widespread media coverage both nationally and in local markets where hospitals were rated as doing particularly well or badly. The Imperial researchers compared the centers named as best and worst with the others, excluding those with only a small number of maternity admissions. They looked at the number of maternity admissions for each center and survey satisfaction levels in 2007 and 2010. The data showed no significant difference in admissions in the three years after the media reports at the best or worst trusts. The research is published in the Journal of Health Services Research & Policy.