Public Health Matters | Hospital ratings in the public domain

Hospital Ratings in the public domain is a public health strategy that has been implemented widely in an international setting.


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Hospital Ratings in the public domain is a public health strategy that has been implemented widely in international settings as a form of reducing information asymmetry, promoting quality of care and even encouraging competition for better quality and healthcare related outcomes amongst hospitals. A widely known example is the U.S Centers for Medicare & Medicaid Services (CMS), namely the Care Compare website. Recently, we’ve seen some funders try to replicate this in South Africa, with private hospitals.


Medical Care Compare

The intention of the Medicare Care Compare is to provide consumers with easy to comprehend, comparable data on outcomes related to healthcare quality in order to inform consumer’s decision-making. The methodology behind this type of data is statistically complex, using analytical concepts such as risk-adjustment, benchmarks, thresholds etc that are not easily understandable to the lay consumer. For this reason, reporting classification is usually displayed into more digestible tiers or categories that reflect whether hospital performance is statistically significant by translating data into statistically above (top-tier), below (bottom tier) or no different (middle tier) to the national comparable average.


A study conducted in 2014 used cross-sectional Medicare Hospital Compare data in the public domain to compare three readmission and three outcome measures showed no statistically significant difference when comparing each hospital in the top or bottom performance tier to those in the middle tier (1). This highlights one of the caveats of using tiers or categories when displaying this type of data.

Another study assessed the difference in four publicly available hospital rating systems in the US by comparing 844 high-performing (top tier) hospitals using four different rating tools (2). Their findings showed that no hospital was a top performer in every tool, with a mere 10% of the 844 hospitals rated as a high performer in one rating system being consistent in any of the other three rating systems (2). This highlights the need for transparency of methodology used in calculating hospital rating, as well as the need for an accepted standard that may be used to rate hospitals fairly (2).


A more recent paper published in 2020, analysed the 2017 Medicare Hospital Compare Program and showed that hospitals that are located in previously disadvantaged areas have lower ratings than hospitals in affluent locations (3). This is especially relevant in a country like South Africa where health inequities are still prevalent and affecting majority of the country’s population. Hospitals shouldn’t be rated poorly compared to their competitors just for serving lower income communities where populations may have risk factors that make them prone to readmissions for instance. Factors that may contribute to unnecessary readmissions are sometimes related to social determinants of health, for example access to a pharmacy for medication to control symptoms, or access to clean running water to attend to wounds and so on.

Hospital ratings are a step in the right direction in terms of improving market knowledge and conveying information to consumers in an imperfect market. In order for such rating systems to be most effective methodologies should be as transparent as possible and should incorporate the South African context.



[1] Paddock SM, Adams JL, De La Guardia FH. Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: An analysis of Medicare Hospital Compare ratings. BMJ Quality and Safety. 2015 Feb 1;24(2):128–34.
[2] Austin MM, Jha AK, Romano PS, Singer SJ, Vogus TJ, Wachter RM, et al. National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Affairs. 2015;34(3):423–30.
[3] Fahrenbach J, Chin MH, Huang ES, Springman MK, Weber SG, Tung EL. Neighborhood Disadvantage and Hospital Quality Ratings in the Medicare Hospital Compare Program. Medical care [Internet]. 2020 Apr 1 [cited 2022 Dec 10];58(4):376. Available from: /pmc/articles/PMC7171595/


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