Abstract
Hospital advertising has been touted as a tool to improve consumer decision-making, but little is known about its association with objective measures of hospital quality. To document recent trends in hospital advertising in the US and examine the association between concurrent measures of hospital advertising and quality. Retrospective cross-sectional study of all general acute care hospitals operating in the US between January 2008 and December 2016. Data were analyzed from December 6, 2019, to July 15, 2020. Annualized advertising spending for each hospital as measured by a market research firm. Four composites of hospital performance from the Centers for Medicare & Medicaid Services Hospital Compare database were used: risk-standardized mortality rate, risk-standardized readmission rate, Consumer Assessment of Healthcare Providers & Systems (CAHPS) Overall Patient Experience Rating (scale of 1-5; higher scores indicate a more positive patient experience rating), and overall 5-star rating. Linear models adjusted for hospital bed size, hospital revenue, and geographic census region. The study sample included, on average, 4569 general acute care hospitals per year between 2008 and 2016. During this time, approximately half of acute care hospitals (2239 of 4569 [49%]) advertised their services to consumers and spent a total of $3.39 billion. Relative to hospitals that never advertised, advertising hospitals were more likely to be nonprofit facilities (mean [SD], 66% [47%] vs 51% [50%]; P < .001), had larger bed sizes (mean [SD], 234.3 [210.7] beds vs 84.8 [110.6] beds; P < .001), and had higher net incomes (mean [SD], $17 800 000 [$49 000 000] vs $134 099 [$51 600 000]; P < .001). There was no observed association between hospital advertising and performance. For example, hospitals that advertised had a mean (SD) CAHPS 5-star rating of 3.2 (0.9) stars compared with 3.3 (1.0) stars among hospitals that did not advertise, an insignificant difference (P = .92). We observed no difference in performance between advertising and nonadvertising hospitals in 30-day readmission rates (mean [SD], 15.5% [0.8%] vs 15.6% [1.0%]; P = .25), mortality rates (mean [SD], 12.7% [4.0%] vs 12.0% [4.1%]; P = .46), and overall 5-star hospital ratings (mean [SD], 3.1 [0.8] stars vs 3.0 [0.9] stars; P = .50). A significant difference was observed in adjusted mortality rates across terciles of advertising spending, with lower mortality rates for the hospitals with higher ad spending (2016, mean [SD] mortality composite for hospitals in the highest tercile, 11.2% [4.2%] vs hospitals in the middle tercile, 12.0% [3.8%], and for hospitals in the lowest tercile, 12.7% [4.1%]; P = .003). The results of this cross-sectional study suggest that the amount hospitals spent on direct-to-consumer advertising was not associated with publicly reported measures of hospital quality; instead, hospital advertising spending was higher for financially stable hospitals with higher net incomes.
Highlights
IntroductionDirect-to-consumer advertising (DTC) is a common feature of competitive health care markets, with a reported $29 billion spent on health care advertising in the US in 2016.1-4 In theory, DTC advertising allows organizations to inform consumers about the breadth and quality of services they offer, increasing awareness and improving decision-making.[5,6] In practice, DTC advertising in health care has been found to include misleading or inaccurate statements, perhaps owing to limited oversight, raising concerns that advertising may be a mechanism for health care organizations to increase the demand for potentially unneeded services.[7,8,9,10] Hospital advertising presents a challenge for regulators who must balance the potential benefits of informing consumer choice against the need for guardrails to protect unsuspecting patients
US Hospital Advertising and Association With Hospital Performance. The results of this cross-sectional study suggest that the amount hospitals spent on direct-to-consumer advertising was not associated with publicly reported measures of hospital quality; instead, hospital advertising spending was higher for financially stable hospitals with higher net incomes
Prior work has shown that hospital advertising influences consumer choices, but it is unknown whether it sways consumers to make better decisions.[11,12,13]
Summary
Direct-to-consumer advertising (DTC) is a common feature of competitive health care markets, with a reported $29 billion spent on health care advertising in the US in 2016.1-4 In theory, DTC advertising allows organizations to inform consumers about the breadth and quality of services they offer, increasing awareness and improving decision-making.[5,6] In practice, DTC advertising in health care has been found to include misleading or inaccurate statements, perhaps owing to limited oversight, raising concerns that advertising may be a mechanism for health care organizations to increase the demand for potentially unneeded services.[7,8,9,10] Hospital advertising presents a challenge for regulators who must balance the potential benefits of informing consumer choice against the need for guardrails to protect unsuspecting patients. Prior studies have found that cancer center advertisements were more likely to promote the benefits of treatments rather than their potential risks; in addition, cancer center advertisements tended to be overly optimistic in relaying prognoses.[15,17,18] To our knowledge, few studies have examined the use of advertising by general hospitals and, in particular, whether it is more common among high-quality hospitals.[1,18]
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