Comparing hospital performance and informing patient choice

One of the greatest challenges facing the medical tourism sector is providing comparable information to patients that can help them to make the right choice of hospital for their treatment. Comparing the performance of hospitals within one country is hard enough; comparing the performance of hospitals in different countries is a near impossible task.

Comparing hospitals – lessons from the USA

A recent article in the British Medical Journal, has highlighted the problems that have arisen in the USA with hospital ranking and hospital comparisons. There’s a multitude of systems in the USA that publish comparisons and rankings of US hospitals.

  • US News and World Report Best Hospitals Guide
  • Healthgrades
  • Leapfrog
  • Consumer Reports
  • Center for Medicare and Medicaid Services

But a recent study has pointed out the shortcomings of the systems. An article,” National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity” published in Health Affairs, reviewed the ratings given to US hospitals by US News, Healthgrades Leapfrog and Consumer Reports. The study found that:

“No hospital was rated as a high performer by all four national rating systems. Only 10 percent of the 844 hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems.”

So, four hospital rating systems all said “these are the best hospitals” but delivered different results. One example highlighted is the Fort Lauderdale area of Florida. In this instance, 21 out of the 24 hospitals in Fort Lauderdale were ranked very highly by at least one rating source. In Baltimore, Maryland region, 19 out of 22 hospitals earned an award for outstanding performance.

If you were a resident of Fort Lauderdale or Baltimore, which hospital, out of the 21 or the 19 respectively, would you choose for treatment?

Thus Baptist Hospital of Miami features the “US News Best Regional Hospital” award on its home page but doesn’t mention the other three rating systems that may have viewed it less favourably. On Healthgrades, the scorings for Baptist Hospital of Miami put it in the average category for many procedures.

According to the BMJ article, one of the study’s authors, Timothy Vogus, associate professor at Vanderbilt University’s Owen Graduate School of Management, says:

“There’s essentially no agreement about what the top hospitals are, and in some cases a hospital rated top by one is at the bottom according to another. There are huge differences in what they measure.”

The role of marketing in hospital awards

Of course, the marketing teams in the US hospitals see the benefit of these rating systems. A savvy marketing team selects the rating system that gives their hospital a great score, and highlights this in their promotion. The rating system provider benefits from payments made to them for the hospital to license the use of the award to promote their excellence. The issue of payments for licensing awards is discussed in “Should hospitals pay to promote a U.S. News & World Report award?”.

“The small gold badge, emblazoned with “Best Hospitals,” comes at a hefty price. If you want to put that badge on any of your marketing materials, you’ll be asked to sign a yearly licensing agreement. Cleveland Clinic has a licensing agreement for digital, print, TV, and radio spots with U.S. News….. Children’s Hospital Boston uses the U.S. News signage and logo in elevators, throughout buildings, in advertising campaigns, at conferences, and on its website”.

What does it cost to license a US News award? According to the article, Boston Children’s Hospital paid $40,000 for its licensing agreement. University of Utah Health Care was asked to pay around $30,000 and one hospital marketing department is quoted as saying its hospital paid $230,000 to use the U.S. News award to promote five of its hospitals.

A definitive solution?

US News believes its latest approach to measuring hospital quality will provide a definitive solution. The new Best Hospitals for Common Care ratings cover nearly every hospital in the country and evaluate each one in five common surgical procedures and medical conditions that account for millions of hospitalizations a year. The UK based firm, Dr Foster was brought in by US News to help devise the new system. Dr Foster has been instrumental in developing the systems used to assess the performance of NHS hospitals in the UK.

But the day when a medical tourist will be able to make a realistic comparison of two hospitals in different countries are a long way off.

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Keith Pollard
As Editor in Chief of International Medical Travel Journal (IMTJ) and a Healthcare Consultant for LaingBuisson, Keith Pollard is one of Europe’s leading experts on private healthcare, medical tourism and cross border healthcare, providing consultancy and research services, and attending and contributing to major conferences across the world on the subject. He has been involved in private healthcare, medical travel and cross border healthcare since the 1990s. His career has embraced the management of private hospitals in the UK, research and feasibility studies for healthcare ventures, the marketing and business development aspects of healthcare and medical travel and publishing, research and consultancy on cross border healthcare.