Working Paper: NBER ID: w8697
Authors: David Dranove; Daniel Kessler; Mark McClellan; Mark Satterthwaite
Abstract: Health care report cards - public disclosure of patient health outcomes at the level of the individual physician and/or hospital - may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals incentives to decline to treat more difficult, severely ill patients. Whether report cards are good for patients and for society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality, and appropriateness of medical treatment that they induce. Using national data on Medicare patients at risk for cardiac surgery, we find that cardiac surgery report cards in New York and Pennsylvania led both to selection behavior by providers and to improved matching of patients with hospitals. On net, this led to higher levels of resource use and to worse health outcomes, particularly for sicker patients. We conclude that, at least in the short run, these report cards decreased patient and social welfare.
Keywords: health care report cards; patient outcomes; provider selection; cardiac surgery
JEL Codes: I1; L5
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| report cards (Y10) | shift in patient selection towards healthier patients (I11) |
| shift in patient selection towards healthier patients (I11) | higher resource use (Q21) |
| shift in patient selection towards healthier patients (I11) | worse health outcomes for sicker patients (I14) |
| report cards (Y10) | improved matching of patients with hospitals (I11) |
| improved matching of patients with hospitals (I11) | worse health outcomes for sicker patients (I14) |
| report cards (Y10) | decreased patient and social welfare (I39) |