German Hospital Quality Not Improved by Public Reporting

Hospital quality has been measured and made publicly available for more than two decades in the US. In Germany, similar efforts were launched in 2004, when all acute care hospitals began being required to report structural, process, and outcome indicators as part of a national quality monitoring program. Hospitals are now mandated to submit quality reports annually. 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. In an analysis about the successes of quality measurement to date, Esra Eren Bayindir and Jonas Schreyögg, both of the University of Hamburg, reviewed quality indicators for 2012–19, examining data for several common health services performed in hospitals, including hip and knee replacements, pressure ulcers, and childbirth. The authors found that, on average, hospitals with low quality ratings were more likely to move to a higher quality category, but hospitals with high quality ratings were more likely to move to a lower category. According to the authors, although hospitals' overall motivation and market forces play roles in improving quality, they are not sufficient to maintain the quality of high-performing hospitals. The authors' findings support the idea that in Germany, public reporting provides an important quality benchmark. However, they conclude, quality improvement has not been achieved for some indicators, even in the absence of price competition. They recommend making hospital quality information more accessible to the public, especially to those with limited health literacy, and to further promote its use among referring physicians to serve as a potential base for selection and to speed up quality improvement.