Amid a push by federal and state health officials and private insurers to
expand the availability of information on the prices and quality of care in
the United States, European health officials have noted that such an approach
introduces new challenges.
Most research on European health care programs that make price and
quality-of-care information available to the public shows that consumers
generally don't use the information to make health care decisions, said marc
Berg, a partner at Plexis Medical Group, a Dutch insurance firm.
He offered his observations at a November congressional briefing during the
2006 International Symposium on Health Care Policy, an annual summit hosted by
the Commonwealth Fund and the Alliance for Health Reform.
Berg said the European public has, however, responded to health data
information in cases in which information is presented in a timely and
understandable way. But, he noted, "If you look at the same literature,
you would realize that much of the information presented to consumers or
patients is at the wrong level."
An example in which health information for the public achieved its goal was
that of a dutch cardiovascular center about which the local media reported
serious safety deficiencies; the center then saw a 50 percent drop in its
patient load as patients sought care elsewhere.
While public access to medical information is usually beneficial, the
patients may need help in understanding the significance of the range of
information available. Roger Boyle, M.D., national clinical director for heart
disease at the U.K. Department of Health, said at the briefing that a"
facilitator" who helps patients search for and understand medical
quality data could increase the use and usefulness of publicly available
quality and price data. A publicly available database of physician quality
reports and patient outcomes, which was developed as part of a continuing
British effort to improve cardiovascular health, was designed using feedback
from tests with patient groups to ensure that the information was accessible
"There is a real challenge here in raising patient awareness,"
Although the financial implications of increased quality and price
reporting remain unclear, attendees were adamant that the steady increases in
public and private medical costs make expanded use of such reporting
The Commonwealth Fund's 2006 Health Policy Survey found that U.S. Public
health care spending is comparable to that of most European countries, but
that spending is in addition to massive private and out-of-pocket spending
that is largely a characteristic of the U.S. System. Not only has annual
growth in medical costs exceeded the rate of inflation for several years, but
also estimates predict that federally funded health care costs alone will
exceed the historic rate of federal spending on health and nonhealth programs
combined by 2050.
In the context of increasing cost pressures in what is already the world's
most expensive per-capita health care system, both U.S. and European health
officials said that making price and quality information available to the
public is likely to become a more popular strategy.
David Fisher, director of health policy for the Senate Budget Committee,
described a huge push for price and quality data transparency over the last
year from the Bush administration and federal law-makers through the Centers
for Medicare and Medicaid Services (CMS).
"That information is critically important to patients, and it is
sorely lacking in the United States," he said. "The lack of
transparency that we have allows providers who [perform poorly] to hide and
get away with performing badly."
Pilot CMS projects to gather quality and comparative price information from
clinicians and hospitals will be bolstered, Fisher said, by such legislative
efforts as the medicare Quality Enhancement Act (S 3900), which would
authorize the release of medicare data to qualified organizations to develop
cost and quality reports while safeguarding patient privacy. The reports would
be available to the public within one year. The bill, which was introduced
late in the year, was referred to the Senate Finance committee.
"Clinical data is the best way to measure performance, but we don't
have that so we need to start with claims data," Fisher said at the
Supporters of publicly available price and quality information said such
measures could spur competition among health care professionals to provide
better and more cost-effective care. Jonathan Perlin, M.D., former
undersecretary for health in the department of Veterans affairs (VA), said a
program that publicly displayed performance data in different regions served
by the VA helped spur improvements in care by creating a sense of competition
among the different Va regions.
Supporters of publicly available information on quality of care said such a
program would add a competitive motive that would spur clinicians' and
administrators' professional desire to provide even higher-quality care than
their colleagues do.
However, Boyle, the British health official, described the recent
competition among clinicians and medical institutions to provide better care
as "overrated" and said it would not be as effective as systematic
use of bench-marks to ensure that medical procedures are properly
The Dutch health care system, which uses closely regulated private
insurers, is better able to utilize clinicians' quality and price reporting
data, said Berg. They are more effective in the Netherlands because the
insurers study the data and can create incentives for the public to obtain
care from the most cost-effective providers.
"Having insurers set the prices provides an incredible stimulus for
[health care] providers to improve," Berg said.