Determinants of nursing home choice: Does reported quality matter?

Quality report cards addressing information asymmetry in the health care market have become a popular strategy used by policymakers to improve the quality of care for older people. Using individual level data from the largest German sickness fund merged with institutional level data, we examine the relationship between reported nursing home quality, as measured by recently introduced report cards, nursing home prices, nursing home's location, and the individual choice of nursing homes. Report cards were stepwise introduced as of 2009, and we use a sample of 2010 that includes both homes that had been evaluated at that time and that had not yet been. Thus, we can distinguish between institutions with above and below average ratings as well as nonrated nursing homes. We find that the probability of choosing a nursing home decreases in distance and price. However, we find no economically significant effect of reported quality on individuals' choice of nursing homes.     

Start spreading the news: a structural estimate of the effects of New York hospital report cards

Research on the effects of publicly reported hospital quality report cards on patient market shares is mixed. Higher-ranking hospitals do not consistently experience increases in market share. We argue that this may be because the report cards do not always convey "news" about quality; in some cases the rankings conform with prior beliefs about quality. We develop a structural model of the "news" in report cards and estimate the model using data from New York State in 1989-1991. We show hospitals with negative news in the original 1990 report cards experienced a decrease in market share, but that a misspecified model might continue to find no report card effect.     

HMOs: responding to bad report cards

Differentiating one health plan from another is becoming increasingly difficult. But a plethora of report cards on plans' performance are now available to help purchasers pick and choose managed care for their members. When a health plan receives a low score--or a score lower than its competitors, be it ever so slight--does it respond appropriately? Are leaders adequately following up to determine the significance of the scoring, rectify the problem--and communicate that to purchasers? Is quality improvement an outcome of publishing report cards? TQL spoke with health plan leaders, healthcare consultants and purchasers to find out what some plans are doing--and what many should be doing.     

Do bad report cards have consequences? Impacts of publicly reported provider quality information on the CABG market in Pennsylvania

Since 1992, the Pennsylvania Health Care Cost Containment Council (PHC4) has published cardiac care report cards for coronary artery bypass graft (CABG) surgery providers. We examine the impact of CABG report cards on a provider's aggregate volume and volume by patient severity and then employ a mixed logit model to investigate the matching between patients and providers. We find a reduction in volume of poor performing and unrated surgeons’ volume but no effect on more highly rated surgeons or hospitals of any rating. We also find that the probability that patients, regardless of severity of illness, receive CABG surgery from low-performing surgeons is significantly lower.     

Employer-specific versus community-wide report cards: is there a difference?

This article describes preliminary results from a natural experiment that tested the impact of report cards on employees. As part of the 1995 enrollment process, some members of the State of Minnesota Employee Group Insurance Program received report cards on the plans offered to them, and others did not. Both groups of employees had a chance to review a second community-wide report card covering all Minnesota plans that had been distributed by an independent organization through local newspapers. Both groups were surveyed before and after they made their health plan selections. We compare the likelihood of seeing, the intensity of reading, and the perceived helpfulness of the first, employer-specific report card with the second, community-wide report card for consumers who make plan selections.     

Nutrition Measures for Managed Care Report Cards

Health plan “report cards,” that is, published summaries of health plan performance, are a new way to help consumers select a health plan on the basis of cost and quality. The Health Plan Employer Data and Information Set (HEDIS) includes a set of health plan performance measures, standardized definitions, and methods for data collection. HEDIS is used as the basis for many report card initiatives and is the preferred tool of the managed care industry for measuring health plan performance. Nevertheless, the current list of HEDIS performance measures omits many health services, including medical nutrition therapy. Nutrition measures have the potential for wide appeal among health care stakeholders (ie, payers, consumers, and providers). Four measures related to medical nutrition therapy are proposed for managed care report cards: staffing for nutrition services and medical nutrition therapy for high cholesterol level, gestational diabetes, and cardiovascular disease. Barriers to adopting medical nutrition therapy measures in HEDIS include the need to address technical issues before considering new measures and competition from other potential measures. Steps to create support for medical nutrition therapy measures in HEDIS should focus on influencing representatives of health plans and employers to include these measures. The involvement of registered dietitians in the dynamic process of health plan evaluation is an important extension of ongoing efforts for strategic positioning in the managed care market. J Am Diet Assoc. 1996; 96:374-380.     

Increasing the impact of health plan report cards by addressing consumers' concerns

Most plan report cards that compare the performance of health plans have framed the decision about plan choice as an opportunity to get better-quality care. This study uses a controlled experimental design to examine the effect of reframing the health plan choice decision to one that emphasizes protecting oneself from possible risk. The findings show that framing the health plan decision using a risk message has a consistent and significant positive impact on how consumers comprehend, value, and weight comparative performance information.     

Validity of self-reported health plan information in a population-based health survey.

OBJECTIVE: To validate information on private health insurance coverage in a population-based study. METHODS: Respondents to the Massachusetts Behavioral Risk Factor Surveillance System were asked the name of their health plan company (affiliation) and specific brand of insurance (product), the duration in which they belonged to the plan, and demographic and health-related data. Information on plan affiliation and product was used to classify individuals on type of coverage. At the end of the survey, respondents with health insurance were asked to retrieve their health plan cards, and to read detailed information from the cards. Self-reported data were compared with information from the cards. RESULTS: Self-reported information on health plan affiliation agreed with plan cards for 93 percent of individuals, while agreement was 79 percent for health plan product. Among health maintenance organization (HMO) participants, 93 percent correctly reported being in an HMO (sensitivity), whereas 76 percent of respondents in a non-HMO plan correctly self-reported (specificity). Individuals with higher levels of income, those with a primary care doctor, and those in a health plan for at least 1 year had higher agreement. Higher validity was associated with poor physical health and recent cancer screening. CONCLUSIONS: Self-reported data on health plan affiliation and product have good validity in a population-based sample of adults. While agreement differs according to specific respondent characteristics, these differences do not appear substantial.     

影响村卫生室医务人员报告法定传染病因素分析

目的找出村医漏报传染病的原因,为制定相关政策提供依据。方法采用分阶段整群抽样法,从河南省报告水平中等县随机抽出一个平原县和一个山区县作为样本县,每个样本县随机抽4个乡镇作为样本乡,对样本全体村医进行调查,统计分析采用非条件logistic归因分析。结果"接诊过传染病人"、"有乡村医师资格"、"掌握传染病诊断标准数"、"传染病相关知识得分"、"有传染病报告卡"以及"报告传染病没有报酬"均与被调查人是否报告传染病有关。结论诊断传染病的技术水平低,从事防保工作没有报酬以及缺乏必要的报告工具是影响河南省村医报告法定传染病的主要因素。     

Making the grade: update on report card initiatives for 1997

Report cards for healthcare services are increasingly in the news, offering the hope that objective information on the quality of health plan and providers services will eventually enable purchasers and consumers to make selections based on true value. Following is a series of five brief articles that review ongoing report card initiatives in private and public sectors of the behavioral healthcare system. The first four articles review actual report cards designed to hold organizations--particularly managed care--accountable for the quality of their services. The last article reviews research on performance measurement across all segments of the behavioral healthcare industry.     

2007年兖州市传染病疫情网络直报质量分析

[目的]了解兖州市2007年传染病疫情网络直报质量,发现问题,总结经验,为进一步提高我市传染病疫情网络直报质量提供科学依据。[方法]使用Excel对2007年充州市报告单位信息和全部传染病报告卡进行分析,对报告单位的类型、报告情况、病例的重复报告、报告审核及时性、完整性进行综合分析评价。[结果]2007年全市共建立报告单位24个,其中18个单位通过系统报告传染病报告卡2002张。全市传染病报告及时率为97．62％,审核及时率为98．63％。从诊断到审核的平均间隔为0．40d,无重卡,未填写工作单位的传染病报告卡占63．08％。[结论]2007年传染病疫情网络直报工作虽然取得了一定成绩,但在报告单位网络直报率、报告审核及时率、报告卡填写完整率等方面仍需进一步提高。     

Meeting information needs to facilitate decision making: report cards for people with disabilities.

BACKGROUND: Several states within the United States offer low-income adults with disabilities a choice of health plans. No states issue comparative 'report cards' specifically for adults with disabilities. OBJECTIVE: To explore conceptualizations of quality, information needs, and report card preferences from the perspective of people with disabilities. RESEARCH DESIGN: Eight focus group interviews were conducted in 2003. Existing report cards for California, Maryland, Michigan and Texas were shared for feedback. SUBJECTS: 34 women and 15 men with various behavioural, physical or sensory disabilities in Oregon, California, Virginia, Maryland and the District of Columbia. RESULTS: Quality was mostly defined in terms of choice and disability sensitivity of service providers. Respondents identified various obstacles to receiving appropriate health plan and service information. All beneficiaries were keenly interested in the comparative health plan report cards, but did not think the report cards provided enough pertinent information, especially with regard to provider ratings, accessibility, disability competence and reasons for participating in the Medicaid program. CONCLUSIONS: Existing comparative report cards omit several major content domains important to people with disabilities. Organizations providing decision support to people with disabilities should cultivate novel avenues for distribution, such as food banks, libraries and places of worship.     

The impact of public performance reporting on health plan selection and switching: A systematic review and meta-analysis

The dissemination of public performance reporting (PPR) cards aims to increase utilisation of information on quality of care by consumers when making health plan choices. However, evaluations of PPR cards show that they have little impact on consumer choices. The aim of this study is to undertake a systematic review and meta-analysis of the impact of PPR cards in promoting health plan selection and switching between health plans by consumers. We searched five online databases and eight previous reviews for studies reporting findings on PPR and health plans. We extracted data and conducted quality assessment, systematic critical synthesis and meta-analyses on the included studies. We identified eight relevant health plan articles related to selection (n?=?2), switching (n?=?4), selection/switching (n?=?2). Meta-analyses showed that PPR was associated with an improvement in health plan selection and a very small deterioration in switching health plans though these changes were not statistically significant. Differences were observed between employer-sponsored health insurance and Medicare/Medicaid insurance. Given the small number of studies included in the review, further research examining the impact of PPR on health plan selection and switching in a range of insurance markets is required.     

Hospital report cards: Quality competition and patient selection

Hospital ‘report cards’ policies involve governments publishing information about hospital quality. Such policies often aim to improve hospital quality by stimulating competition between hospitals. Previous empirical literature lacks a comprehensive theoretical framework for analysing the effects of report cards. We model a report card policy in a market where two hospitals compete for patients on quality under regulated prices. The report card policy improves the accuracy of the quality signal observed by patients. Hospitals may improve their published quality scores by costly quality improvement or by selecting healthier patients to treat. We show that increasing information through report cards always increases quality and only sometimes induces selection. Report cards are more likely to increase patient welfare when quality scores are well risk-adjusted, where the cost of selecting patients is high, and the cost of increasing quality is low.     

Do markets respond to quality information? The case of fertility clinics

Although policymakers have increasingly turned to provider report cards as a tool to improve health care quality, existing studies provide mixed evidence on whether they influence consumer choices. We examine the effects of providing consumers with quality information in the context of fertility clinics providing Assisted Reproductive Therapies (ART). We report three main findings. First, clinics with higher birth rates had larger market shares after the adoption of report cards relative to before. Second, clinics with a disproportionate share of young, relatively easy-to-treat patients had lower market shares after adoption versus before. This suggests that consumers take into account information on patient mix when evaluating clinic outcomes. Third, report cards had larger effects on consumers and clinics from states with ART insurance coverage mandates. We conclude that consumers respond to quality report cards when choosing among providers of ART.     

死亡病例网络直报工作存在问题与对策探讨

目的发现和了解死亡病例网络直报工作中存在的问题,为此项工作的不断完善提供对策性研究。方法对2004年以来"死因登记报告信息系统"中平顶山市报告病例卡片出现的错误进行归纳分类,结合对错误卡片的核查结果和审核订正记录资料分析错误发生的原因。结果在含有错误(或瑕疵)的报告卡片中,死因诊断不明的占10%,因既往史资料收集不全导致报告错误的占15%,诊断明确但死亡报告卡填写错误的占75%;ICD-10死因分类知识培训不到位,临床医生不了解死亡证明书填写规则,管理制度不完善,是影响死因报告工作质量的主要原因。结论对临床医生和疾病控制机构死因报告人员分层次进行培训,健全管理制度,完善考评机制,是降低错误率、提高报告质量的关键环节。     

Patients' preferences for technical versus interpersonal quality when selecting a primary care physician

OBJECTIVE: To assess patients' use of and preferences for information about technical and interpersonal quality when using simulated, computerized health care report cards to select a primary care provider (PCP). DATA SOURCES/STUDY SETTING: Primary data collected from 304 adult consumers living in Los Angeles County in January and February 2003. STUDY DESIGN/DATA COLLECTION: We constructed computerized report cards for seven pairs of hypothetical individual PCPs (two internal validity check pairs included). Participants selected the physician that they preferred. A questionnaire collected demographic information and assessed participant attitudes towards different sources of report card information. The relationship between patient characteristics and number of times the participant selected the physician who excelled in technical quality are estimated using an ordered logit model. PRINCIPAL FINDINGS: Ninety percent of the sample selected the dominant physician for both validity checks, indicating a level of attention to task comparable with prior studies. When presented with pairs of physicians who varied in technical and interpersonal quality, two-thirds of the sample (95 percent CI: 62, 72 percent) chose the physician who was higher in technical quality at least three out of five times (one-sample binomial test of proportion). Age, gender, and ethnicity were not significant predictors of choosing the physician who was higher in technical quality. CONCLUSIONS: These participants showed a strong preference for physicians of high technical quality when forced to make tradeoffs, but a substantial proportion of the sample preferred physicians of high interpersonal quality. Individual physician report cards should contain ample information in both domains to be most useful to patients.     

The effect of commitment to the organization on physicians' familiarity with guidelines for diabetes in managed care organizations

Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.     

Competition and the impact of online hospital report cards

Information on the quality of healthcare gives providers an incentive to improve care, and this incentive should be stronger in more competitive markets. We examine this hypothesis by studying Pennsylvanian hospitals during the years 1995–2004 to see whether those hospitals located in more competitive markets increased the quality of the care provided to Medicare patients after report cards rating the quality of their Coronary Artery Bypass Graft programs went online in 1998. We find that after the report cards went online, hospitals in more competitive markets used more resources per patient, and achieved lower mortality among more severely ill patients.