Maxwell C I
AMP Incorporated, Harrisburg, PA 17105-3608, USA.
Jt Comm J Qual Improv. 1998 Sep;24(9):491-502. doi: 10.1016/s1070-3241(16)30398-4.
Forty states have now passed legislation establishing governmental agencies charged with the task of gathering hospital-level data. Since 1988 all acute care hospitals in Pennsylvania have been submitting data to the Pennsylvania Health Care Cost Containment Council (PHC4). Pennsylvania's policy was designed to make patients and purchasers more informed and selective buyers of medical services, to increase the public accountability of providers of these services, and to encourage hospitals and physicians to compete more on clinical outcomes and charges. The impact of Pennsylvania's policy of public disclosure of performance information on hospital charges over time has not previously been evaluated. Nor has the importance that hospital executives assign to the publication of comparative charges and clinical outcomes information been assessed.
From 1990 through 1994 the PHC4 published a number of hospital-level performance reports (including the regional Hospital Effectiveness Reports and A Consumer's Guide to Coronary Artery Bypass Graft Surgery) containing hospital average charges, average lengths of stay, a rating of severity of illness, and two outcome measurements--morbidity and in-hospital mortality--on a total of 59 diagnosis-related groups. An 18-item survey designed to assess hospital executives' opinions of the usefulness and importance of the PCH4 information was sent to the chief executive officers at the study hospitals.
There were no significant trends toward a reduction in the dispersion of charges in either category of hospitals during the study period. Most hospital executives assigned low ratings of importance to published comparative charges information; however, executives of high-competition hospitals assigned significantly higher importance ratings to the information as a whole in enouraging hospital competition based on quality.
