Public Reporting Of Hospital Quality Measures Has Not Led To Overall Quality Improvement: Evidence From Germany

Abstract

Hospital quality has been measured and made publicly available for decades in the US and for more than a decade in Germany, as part of an effort to help those countries achieve quality improvement. The German hospital market presents a unique opportunity to examine the relationship between public reporting and quality improvement in the absence of performance-linked payment incentives in a high-income country. We considered quality indicators from several important categories of health services provided in hospitals (hip, knee, obstetrics, neonatology, heart, neck artery surgery, pressure ulcers, and pneumonia), using structured hospital quality reports from the period 2012-19. Our findings support the idea that public reporting provides a quality benchmark and prevents the provision of very low quality health care services, suggesting that imposing financial punishment on low performers is not necessary and may hinder quality improvement and aggravate health disparities. Although hospitals' intrinsic motivation and market forces play roles in improving quality, they are not sufficient to maintain the quality of high-performing hospitals. Therefore, in addition to rewarding high-performing institutions, aligning quality incentives with the intrinsic professional values of clinical care may be useful in achieving quality improvement.