The role of information and competition on hospital performance

In the last decades the amount of information on clinical outcomes available to patients, doctors, healthcare managers and politicians has increased dramatically. The general idea is that improved and increased information should allow managers and doctors to improve quality, either through managerial practice or reputation. It should also help patients to choose where to seek medical care, thus improving healthcare outcomes through a number of channels. Hospitals may be more under pressure to improve performance only in situations in which patients have indeed a choice, i.e. when they can receive medical attention from more than one outlet within reach.
“The role of information and competition on hospital performance” is the title of the speech given by Emanuele Bracco in the “Health needs and resources: allocation and measurement issues” conference hosted by the Università degli Studi di Urbino Carlo Bo
In Italy the Health Ministry has implemented a National (Clinical) Outcome Programme (PNE, Programma Nazionale Esiti), under which almost two hundred clinical outcomes are collected yearly. Since 2016 this data is fully available to the public, prior to that it was only available to professionals within hospitals.
The aim of this work, carried out in the context of the FLASH project, is to look into the effect of the collection and release of information and competition among hospitals. The focus is on the share of patients receiving a surgery within two days for femur fracture. It is well known that a speedy surgical operation is massively important for a patient’s recovery and autonomy. The share of surgeries within two days is positively affected by the release of information only in localities in which there is sufficient competition among hospitals. After the release of clinical information to the public, hospitals subject to competition increase their performance (measured as the percentage of patients receiving surgery within two days) by up to six percentage points, compared to hospitals not subject to competition. This highlights once more the relevance of collection and publication of clinical outcomes, and that the effect of this may be heterogenous across different contexts.