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“What Have We Learned? As Usual, Nothing”

February 24, 2015
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A year ago, “Saturday Night Live,” the NBC comedic institution, was in hot water for not having a Black woman in its cast. Many argued that it was ridiculous in 2015 that the cast so lacked diversity, it couldn’t have anyone play the President’s wife on a regular basis. 
A few weeks after that debate subsided, the show had Kerry Washington, of “Scandal” fame, as its host. The opening skit played off the controversy, with President Obama (played by cast member Jay Pharoah) telling his wife Michelle (played by Washington) that he hadn’t seen her in a while. Washington then quickly switched into her Oprah costume, when President Obama was told that famous talk show host was there. Then after Washington came out as Oprah, Obama was told that Beyonce was there. The joke went on until six Matthew McConnaugheys showed up and the show “apologized” for the number of famous Black women Washington would have to play that night. They said they’d rectify the situation, “unless they found another white guy they loved first.” 
At the very end, the Rev. Al Sharpton came out and said, “What have we learned from this sketch? As usual, nothing,” before delivering the show’s signature tag line. 
I loved that kicker. It’s a great line that made the whole joke worth it.  (For what it’s worth, the show has since hired two Black women).
When I saw the results of a study published in the Journal of Health Services Research & Policy, I couldn’t help but think of Sharpton’s dry-wit remark. The study, led by researchers at the Imperial College in London, determined that releasing information on the quality of hospitals didn’t lead to an improvement in care or a reduction in cost. 
The researchers used a widely publicized survey from 2008 in the U.K. that listed the best and worst hospitals for maternity care.  They found that patients didn’t decide to use the better-performing institutions, and that satisfaction levels for care did not improve more quickly at hospitals named as the ten worst, compared with others with similar satisfaction levels at the start.
"The National Health Service (NHS) and other health systems are increasingly trying to provide more information about hospitals' performance on the basis that letting patients make informed choices about where they go for their care will improve standards. The evidence for this is patchy, and mainly comes from cardiac surgery in the US. We wanted to test this idea by looking at maternity care in England, since pregnant women might be more proactive in seeking information and choosing in advance where they want to give birth,” stated Anthony Livery, Ph.D., from the School of Public Health at Imperial College London, who led the study.
Livery concludes that based on what they found, public reporting of health information won’t improve care. 
It got my attention because no less than a few weeks ago, I published my interview with Avi Dor, Ph.D.,  the Milken Institute School of Public Health at the George Washington University, where he basically said the opposite. OK it wasn’t the complete opposite, Dor’s thesis focused more on the price of care. But he did say making quality information available creates a competitive environment, which benefits the consumer. In his study, Dor focused on how insurers were negotiating a better price of a costly procedure with hospitals because of web-based quality report cards. 
Other studies have shown that quality-based information can reduce costs and improve care. I thought it was interesting that Dr. Livery would call those findings “patchy” and then definitely go on to say that it won’t improve care. That seems a bit hypocritical. 
The truth is we’re early on in the transparency movement. There are many varying factors that will shape on the true impact of web-based quality and pricing data. Different markets will react differently to different types of quality information. It will take healthcare consumers, who are not used to having this data available, longer to adapt.  No current study will prove or disprove something as nascent as this. It will take years of research, and even then, it may not be enough. 
So what have we learned? As usual, nothing.