title: The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation.
abstract: BACKGROUND
  Increasing competition in health care markets and ongoing pressures to contain costs raise concerns about possible deterioration in the quality of medical care. Publicly disseminated quality report cards are designed to inform consumers' choice of providers and health plans, thus counteracting incentives to provide low-quality care and improving the functioning of health care markets.
  
  
  METHODS
  This article reviews and evaluates the published evidence on the impact of quality report cards on patients' choice of health care providers and health plans.
  
  
  RESULTS
  Studies found only minimal effect of quality report cards on patient referral choices. These findings can be explained by several study design issues and by the economic forces governing health care markets. They cannot be construed to imply that quality report cards are not effective.
  
  
  CONCLUSIONS
  Whether report cards are effective or not is still an unanswered question. Further efforts to improve the information contained in report cards and to make them more understandable could increase their effectiveness.
authors.affiliation: Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. dana_mukamel@urmc.rochester.edu
authors.forename: D B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: A I
authors.initials: AI
authors.lastname: Mushlin
mesh_terms: D002755:Choice Behavior; D006279:Health Maintenance Organizations / Q000592:standards* / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007255:Information Services; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010820:Physicians / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States