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Evaluating quality, waiting times, experience: international comparison

A comparison of public studies from 11 countries highlights that, while disparities persist in the methods, all measure quality of care and time to care.

A comparison of public studies from 11 countries highlights that, while disparities persist in the methods, all measure quality of care and waiting times. 

The assessment of quality, safety, waiting times and patient experience in health systems is becoming increasingly common in high-income countries. However, the approaches and tools implemented in public assessment differ, as highlighted by this article which presents the practices of 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States. 

The development of measures and their publication is linked to the increased demand for transparency and accountability of care providers by civil societies. These measures thus provide patients with the opportunity to make informed choices, which contributes to the general orientation towards patient empowerment. They also enable public actors and legislators to make decisions based on objective data, such as, for example, incentives and/or financial penalties linked to performance. 

The publication of performance data is used as a means to improve the quality of care through two main mechanisms: the selection by users of the best-rated actors, and the resulting incentive for health care providers to change their behavior to move towards more quality. To do this, the published data are then used by the institutions to identify their weak points and to create motivation. 

On the other hand, the public nature of these rankings poses difficulties and opens the door to adverse effects, creating incentives that may jeopardize the quality of care and patient confidence in the long run. Healthcare providers could, for example, refuse to take on at-risk patients that could have a negative impact on their rankings. 

The article presents an overview of existing measures in the 11 countries mentioned, with an inventory that captures the diversity of indicators used and individual situations while pointing out the general trend to highlight these measures. Using a questionnaire filled out by key actors in each country as a basis, the authors highlight the central position that is reserved for measuring waiting times, which is made public for major hospitals in 7 countries. Information on patient experience is also available in most countries, but is generally not extended to the primary care sector. Ethical issues and the potential adverse effects of rating individual healthcare providers are cited as the main barrier to their implementation. 

Only England publishes composite measures on overall safety and quality of care in hospitals for ranking purposes. Here again, the methodological and ethical problems are probably responsible for this state of affairs, alongside the possible negative effects. 

Public reporting on quality, waiting times and patient experience in 11 high-income countries, Bernd Rechel, Martin McKee, Marion Haas, Gregory P. Marchildon, Frederic Bousquet, Miriam Blumel, Alexander Geissler, Ewout van Ginneken, Toni Ashton, Ingrid Sperre Saunes, Anders Anell, Wilm Quentin, Richard Saltman, Steven Culler, Andrew Barnes, Willy Palm et al., Health Policy, Volume 120, Issue 4, April 2016, Pages 377-383 Elsevier. Available at: https://www.sciencedirect.com/science/article/pii/S0168851016300264  

The assessment of quality, safety, time of care and patient experience in health systems is becoming increasingly common in high-income countries. However, the approaches and tools implemented in public evaluation differ, as highlighted by this article which presents the practices of 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Norway, Sweden and the United States.

The development of measures and their publication is linked to the increased demand for transparency and accountability of care providers by civil societies. These measures thus provide patients with the opportunity to make informed choices, which contributes to the general orientation towards patient empowerment. They also enable public actors and legislators to make decisions based on objective data, such as, for example, incentives and / or financial penalties linked to performance.

The publication of performance data is used as a mean to improve the quality of care through two main mechanisms: the selection by users of the best-rated actors, and the resulting incentive, for health care providers , to change their behavior to move towards more quality. To do this, the published data is then used by the institutions to identify their weak points and to create motivation.

The public nature of these rankings, on the other hand, poses difficulties and opens the door to perverse effects, creating incentives that may, in the long run, jeopardize the quality of care and patient confidence. Healthcare providers could for example refuse to take in charge patients at risk that could have a negative impact on their rankings.

The article presents an overview of existing measures in the 11 countries mentioned, an inventory that captures the diversity of indicators used and individual situations while pointing the general trend to highlight these measures. On the basis of a questionnaire filled out by key actors in each country, the authors highlight the central place that is reserved for the measurement of delays in care, which is made public for major hospitals in 7 countries. Information on patient experience is also available in most countries, but is generally not extended to the primary care sector. Ethical issues and the potential adverse effects of rating individual healthcare providers are cited as the main barrier to deployment.

Only England publishes aggregated measures on the safety and overall quality of care in hospitals for classification purposes. Here again, the methodological and ethical difficulties are probably responsible for this state of affairs, alongside the possible negative effects.

Bernd Rechel, Martin McKee, Marion Haas, Gregory P. Marchildon, Frederic Bousquet, Miriam Blumel, Alexander Geissler, Toni Ashton, Ewout van Ginneken, Ingrid Sperre Saunes, public relations on quality, waiting times and patient experience in 11 high-income countries , Anders Anell, Wilm Quentin, Richard Saltman, Steven Culler, Andrew Barnes, Willy Palm et al., Health Policy, Volume 120, Issue 4, April 2016, Pages 377-383 Elsevier. Avalable at: https://www.sciencedirect.com/science/article/pii/S0168851016300264