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Quality Improvement

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Health plan report cards may have limited relevance for certain vulnerable patient groups

The purpose of releasing public data on the quality of various health insurance plans, so-called report cards, is to empower consumers to make informed health plan choices. However, this information may offer little to patients from vulnerable groups, such as the poor, poorly educated, minorities, and those who are chronically ill, according to A. Eugene Washington, M.D., M.Sc., of the University of California, San Francisco.

In a recent commentary on the subject, Dr. Washington and his colleagues cite several areas of concern. For example, these vulnerable groups are among those least likely to have health care choices in the first place and are less likely to access and be able to make sense of the data. The areas of health care measured may have only limited relevance to their everyday health concerns. Also, these vulnerable patients are likely to have been underrepresented in the samples from which the measures were calculated, which may not reflect the sorts of experiences that they can expect from the same health plans.

The public release of data skewed away from the interests of vulnerable patient groups may further enhance neglect of services for them, if indeed, "what gets measured gets attention." Finally, for fear of looking bad in publicly released data, health plans and providers may avoid caring for hard-to-manage individuals, whose care costs are often higher and whose outcomes are poorer.

The researchers, whose work was supported by the Agency for Healthcare Research and Quality (HS07373), recommend development of new measures relevant to vulnerable groups, for example, how health plans perform in the care of sickle-cell disease or access to culturally appropriate care. They also suggest oversampling of minority groups and stratifying the data (for example, by age, ethnicity, or socioeconomic status) to highlight the care of those with distinctive health care experiences and comparing care of similar groups in similar organizations. They further recommend that reimbursement strategies account for the difficulties and excess costs associated with caring for those in hard-to-manage groups.

See "Health care report cards: Implications for vulnerable patient groups and the organizations providing them care," by Huw T.O. Davies, M.A., M.S.C., Ph.D., Dr. Washington, and Andrew B. Bindman, M.D., in the June 2002 Journal of Health Politics, Policy and Law 27(3), pp. 379-399.

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