Transparency in care: how can public quality reporting help to empower patients?
AbstractThe central question in this study is whether enhanced transparency allows an increase in the specific knowledge of one particular group and thereby boosts its power. The new knowledge examined in this case study is the access to public quality reporting (PQR) data by Dutch patients confronted with difficult care choices. PQR describes the practice whereby the information that hospitals collect for their internal quality reporting, is made public.I would like to highlight that the process of making this information public can be regarded as a form of "transparency inward", another central theme of this volume. In my case the inward transparency consists of providing patients with new insights into the quite complex and therefore often in-transparent institution hospital. For a long time hospitals have been collecting data on the quality of their care in order to monitor the performance of their departments (Faber et al., 2009). After the 2001 "landmark report" from the American Institute of Medicine (IOM) policy-makers all over the world wished to increase the transparency of health care systems for patients (Kurtzman & Jennings, 2008, p.349), so that patients could judge the quality of care in hospitals. This led to the creation of multiple PQR initiatives. However, as patients were reluctant to use them, they remained rather unsuccessful (Faber et al., 2009).Starting from the observation that PQR incentives have proven so unsuccessful, the main question of this contribution is how (elective surgery) patients can be encouraged to use public reporting systems to take informed hospital choices. Elective surgery in the medical realm means that the undertaken medical intervention is not performed in a state of emergency and is planned in advance. This project utilizes "targeted transparency" as a lens to review the functioning of PQR systems in a single case study. I pay particular attention to the challenges patients in the Netherlands face when deciding on a hospital to undergo elective surgery. Understanding the current shortcomings is essential before discussing why more targeted transparency is necessary to empower patients to make active care choices. My main research question, therefore, can also be worded differently: which issues make patients reluctant to use public quality reporting data when choosing a hospital for elective surgery? These issues are apparently not a negligible factor, since patients though valuing the provision of PQR data, frequently refrain from using it. Scholars refer to this as the choice-choosing paradox.