Professor Gwyn Bevan: There are systematic reviews in the United States for putting information out on a hospital's performance. They consistently find that people do not switch from poor to high-performing hospitals. One of the paradoxes about the New York study where they issued data on risk-adjusted mortality rates for cardiac surgery is that patients continued to go to hospitals with high mortality rates. But by publishing the information, the hospitals got better. The most famous case is Bill Clinton, who had his quadruple bypass in a hospital that the information said at the time was one of the two worst outliers in the whole of New York State he could have gone to.What Prof Bevan is saying here is that publishing hospital performance, even poor results, will not affect the number patients using the hospital. Patients presumably see themselves as individuals rather than part of an aggregated statistic. Bill Clinton used the hospital he did because he thought that the performance data would not include him. Isn't that what we all think? The interesting part is that publishing the performance data improved the hospital because hospital management were effectively shamed into doing so. They do think in terms of aggregated figures: the hospital's reputation.
The government's faith is that competition and choice will raise standards, whereas it seems that choice will not do that.