NCPA - National Center for Policy Analysis


November 16, 2004

In schools, report cards are given to students to stimulate better academic performance. This same idea has been applied to hospitals that provide cardiac surgery to patients. A new paper from the National Bureau of Economic Research finds that these hospital report cards are effective.

The authors analyzed the Cardiac Surgery Reporting System (CSRS), the nation's longest-standing effort to measure and report health care quality. The CSRS collects data on clinical outcomes and data on the health history of the patient before the operation. Using CSRS data from 1991 to 1999 the authors find that the reporting program has both influenced patients? decisions of which hospital to attend and improved quality of care.

They note that:

  • Those hospitals with low mortality rates see a positive flow of patients in the first year following a report, but this increase declines soon after.
  • In contrast, those hospitals identified publicly as offering relatively low quality surgery experienced a decline of 10 percent in the number of patients during the first 12 month after an initial report and remained at that level for three years.
  • This amounts to about 4.9 fewer surgery patients per month.
  • However, their risk-adjusted mortality rate declined significantly -- about 1.2 percentage points.

The researchers offer several explanations for the changes. Doctors or hospital officials may elect to do fewer procedures. Some surgeons may no operate anymore. Alternatively, the hospitals and surgeons may be making efforts to improve their future quality out of concern for patient health and their reputations.

Source: David R. Francis, "Hospital Report Cards Do Matter," NBER Digest, November 2004; based upon David Cutler, Robert Huckman and Mary Beth Landrum, "The Role of Information in Medical Markets: An Analysis of Publicly Reported Outcomes in Cardiac Surgery," National Bureau of Economic Research, Working Paper No. 10489, May 2004.

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