One-star rating for a five-star program: evaluating ‘Hospital Compare’

For healthcare systems of any size, it is important to minimize costs while maximizing outcomes. One idea of how to achieve these goals has been the reduction in hospital-related complications, including infection and surgical complications, among others. In the United States, policy makers recently adopted the ‘Hospital Compare’ program as a way to encourage consumers and improve hospitals. This article evaluates the effectiveness of this policy. This article uses an observed cohort study of most US hospitals across four different indices. Each observed hospital was evaluated at least once each year over a span of three years for rates of hospital-acquired infections and compared to what reasonably ought to have been the rate based on hospital factors. Hospitals poorly rated in the base year were compared against remaining institutions for their ability to meet national benchmarks in future years. Despite government attempts to show individuals the comparative quality of hospitals, there is little evidence that these informed consumer choices were substantially enough to motivate changes. Across most metrics used, poorly rated hospitals were unlikely to improve at rates that the designers of Hospital Compare would have envisioned. Although it is possible that the effects could shift over time, it is unlikely that the Hospital Compare program properly understood and anticipated patient calculus for choosing a hospital. Technical complexity and other issues further undermined the program. Despite this, the goal of reducing complications is worthwhile, but a different strategy should be pursued. •Positing health outcomes for hospitals was insufficient to spur change.•Poorly rated hospitals were less likely to meet benchmark standards over time.•Alternative proposals should be considered to improve hospital quality.