Utilization of Cesarean Sections: Comparing Hospitals in Indiana

number of citizens will soon have access to health insurance and healthcare. However, it is uncertain if this reform will be able to reduce costs and improve quality. The states will soon change the focus of their health policies from protecting the uninsured to guaranteeing high-quality care at lower costs. Initiatives like the Commonwealth Fund’s State Scorecard on Health System Performance will gain prominence, challenging states to avoid unnecessary care, control costs, and promote healthy lives. The public call for more transparency and accountability in the healthcare system will also present a challenge for states. Growing evidence suggests that healthcare in the U.S. does not perform with the highest standards of quality, and that it ranks low compared with other developed countries [1,2]. Providers now face more requirements to submit performance data, and more organizations are releasing provider quality ratings to the public. One of these initiatives, supported by the U.S. Department of Health and Human Services (DHHS), is the Hospital Compare website. Hospital Compare reports hospital quality measures based on processes and outcomes for many care services. However, because the majority of the data comes from Medicare claims and enrollment, Hospital Compare does not encompass services that are common to a broader spectrum of the population. Despite the clear need for more accountability, two problems threaten the improvement of quality through public disclosure. First, the methodologies to assess quality have limitations. Different public quality reports produce conflicting ratings due to lack of homogeneity in methodologies, data source, and sample selection [3,4]. A hospital may look good under one methodology and bad under another. The lack of validation makes it difficult to discern which rating is right, and, more importantly, makes quality assessment questionable. Quality assessment is connected to patient decisions and providers’ reputation and income. Therefore, conflicting metho dologies will reduce stakeholders’ confidence in public ratings, risking its effectiveness as a vehicle to improve healthcare quality. The second problem is the effectiveness of public disclosure. Several studies question the patient’s capability to use and influence healthcare quality data. With only 12% of Americans proficient in health literacy [5], disclosing information about quality hardly empowers the average patient to choose a provider based on performance. Most patients remain unaware of publicly available quality information. Those who are aware of the available reports may not understand the information [6,7]. Although patients value the disclosure of quality information, they still rely on informal sources, such as family and friends. When it comes to choosing a healthcare provider, the evidence shows that quality plays a small role in the final decision [6]. CENTER FOR HEALTH POLICY MARCH 2011 R E S E A R C H F O R A H E A L T H I E R I N D I A N A