The public gets what the public wants: experiences of public reporting in long-term care in Europe.
BACKGROUND
Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe.


METHODS
Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care.


RESULTS
Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information.


CONCLUSIONS
There was little evidence to show whether public reporting has a significant impact on driving users' choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed.


CONCLUSIONS
The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings.
European Centre for Social Welfare Policy and Research, Berggasse, 17, A-1090 Vienna, Austria. Electronic address: rodrigues@euro.centre.org.
Ricardo
R
Rodrigues
London School of Economics and Political Science, London, UK.
Lisa
L
Trigg
European Centre for Social Welfare Policy and Research, Vienna, Austria.
Andrea E
AE
Schmidt
European Centre for Social Welfare Policy and Research, Vienna, Austria.
Kai
K
Leichsenring
D022126:Access to Information; D019985:Benchmarking / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D002755:Choice Behavior; D005060:Europe; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration / Q000592:standards*; D011639:Public Opinion; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires
Benchmarking; Europe; Long-term care; Patient participation; Quality indicators