The Cleveland Clinic is by far the best provider of cardiac care in the nation. If you have cancer there is no better place to be than Texas. Johns Hopkins is the greatest hospital in the America.
Why? Because US News and World Report suggests as much in its hospital rankings.
But which doctors at the Cleveland Clinic have the highest success rates in aortic valve repair surgeries? What are the standardized mortality rates due to cancer at University of Texas MD Anderson Cancer Center? Why exactly is Johns Hopkins the best?
We don’t have answers to these types of questions because in the United States, unlike in the United Kingdom, data is not readily available to healthcare consumers.
The truth is, the rankings with which most patients are familiar provide users with little. Instead, hospitals are evaluated largely by “reputation” while details that would actually be useful to patients seeking to maximize their healthcare experiences are omitted.
Of course, the lack of data available about US healthcare is not US News and World Report’s fault – it is indicative of a much larger issue. Lacking a centralized healthcare system, patients, news sources, and policy makers are left without the information necessary for proper decision-making.
While the United Kingdom’s National Health Service may have its own issues, one benefit of a system overseen by a single governmental entity is proper data gathering and reporting. If you’re a patient in the United Kingdom, you can look up everything from waiting times for both diagnostic procedures and referral-to-treatment all the way to mortality and outcome data by individual physician.
This is juxtaposed to the US healthcare system, where the best sources of data rely on voluntary reporting of information from one private entity to another.
Besides being riddled with issues, including a lack of standardization and oversight, the availability of data to patients becomes limited, manifesting itself in profit-driven endeavors like US News and World Report or initiatives like The Leap Frog Group that are far less well-known and contain too few indicators to be of real use.
The availability of data in the United Kingdom pays dividends. For example, greater understanding of performance has allowed policy makers to consolidate care centers that perform well and close those that hemorrhage money, cutting costs while improving outcomes. Even at the individual hospital level, the availability of patient data keeps groups on their toes.
Hospitals constantly monitor their outcomes at the procedural level, and if problems do arise they are quick to seek solutions, lest patients make use of the easily accessible data and choose to seek care elsewhere. I know the power that freely available data has to encourage healthcare providers to increase quality of care firsthand, as it is part of the reason I was brought in to consult at one hospital in particular.
In the United Kingdom, the gathering and reporting of data is easy due to the centralization and public nature of the healthcare system, but the United States faces significant barriers to achieving such a free flow of information. For example, private hospitals currently at the top of the arbitrary rankings have little incentive to report detailed outcome data. On a related note, without the larger players taking part, smaller or less prestigious entities trying to prove their worth have nothing to which to compare their own work for the public.
Of course, some private entities and actors in the United States would surely fight against greater oversight, regardless how reasonable oversight by empowered patients may be.
A lack of centrality in US healthcare also leads to issues with standardized reporting. For example, the Mayo Clinic is likely to see much more extreme cases than is a hospital in a small town in Minnesota. Without one body ensuring that all cases are coded according to a standard protocol, there is no way to take into account factors such as severity of illnesses when creating the figures to report to the public.
As such, even if each individual hospital did currently report data on all of its physicians’ outcomes, it might not be comparable across institutions, limiting the usefulness of the exercise.
Private entities and actors within US healthcare claim to have little excitement about government involvement in the system, suggesting it will ultimately create waste and reduce competition in the sector. However, specifically concerning data availability, a look at the United Kingdom would suggest that more centralized oversight does just the opposite while continuing to empower patients.
Whether run through a more robust and better-publicized private initiative or more centralized public entity, the United States can benefit from better monitoring and reporting initiatives in the healthcare sector. Hopefully we are not far away from patients being able to act on more objective data to determine the best hospitals and even the best doctors for their needs.
Alexander Chaitoff is a 2013 Marshall Scholar pursuing his Master of Public Health at the University of Sheffield. He will begin as a first year medical student at the Cleveland Clinic Lerner College of Medicine in the fall of 2014.