Expectations are high that the public will use performance data to choose their health providers and so drive improvements in quality. But in a paper published on bmj.com today, two experts question whether this is realistic.
They think patient choice is not at present a strong lever for change, and suggest ways in which currently available information can be improved to optimise its effect.
Research conducted over the past 20 years in several countries provides little support for the belief that most patients behave in a consumerist fashion as far as their health is concerned, say Martin Marshall and Vin McLoughlin from The Health Foundation.
Although patients are clear that they want information to be made publicly available, they rarely search for it, often do not understand or trust it, and are unlikely to use it in a rational way to choose the best provider, they write.
They suspect that these problems are not just due to inadequate data, but may be the result of “unrealistic expectations” and “inappropriate assumptions” by advocates of public disclosure where health decisions are concerned.
They argue that the public “has a clear right to know how well their health system is working, irrespective of whether they want to use the information” and they suggest several ways in which currently available performance data could be made more useful.
For example, it is important that users perceive the information as coming from a trusted source, they say. It also needs to be of interest to the target audience and presented in a visually attractive way.
Patients also need to know how the NHS works before they can realistically judge comparative performance data, they add, while personal stories can also be compelling and influential when used alongside numeric data.
“In this paper, we present a significant challenge to those who believe that providing information to patients to enable them to make choices between providers will be a major driver for improvement in the near or medium term,” they write. “We suggest that, for the foreseeable future, presenting high quality information to patients should be seen as having the softer and longer term benefit of creating a new dynamic between patients and providers, rather than one with the concrete and more immediate outcome of directly driving improvements in quality of care.”
