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'Expert' thinking on hospital ranking

The Ontario government is considering a ranking system that would award Ontario hospitals stars for good performance, while identifying poor performers, the Ottawa Citizen claims. The “name-and-shame” scheme would be modeled after a short-lived British experiment. 

'Under the proposed system, hospitals would be given a rating of as many as three stars for their performance in areas such as treating patients safely and effectively, reducing surgical and emergency-room waits and improving cleanliness. Another system under consideration would simply rate hospitals “excellent,” “good,” “fair” or “weak,” according to documents released to the Citizen under provincial freedom-of-information laws.

'The merits and pitfalls of a star-rating system were discussed in 2009 by a panel of 13 experts advising Health Minister Deb Matthews on the future financing and accountability of hospitals. However, it’s not clear if the government has adopted the idea.'

The Citizen adds a ranking system "could also lay the groundwork for more sweeping changes to how hospitals are funded, with the goal of rewarding those that are more efficient and treat patients safely and effectively."

The Citizen says some British hospitals manipulated their data to look like they had improved standards when they actually hadn’t.  For example, to meet the target of a maximum four-hour wait for treatment in emergency departments, some hospitals made patients wait in ambulances outside the hospital until staff were confident they could be treated.

While details on the proposal are just emerging, this appears to be one more step towards a system based on competition and fragmentation rather than cooperation and integration.  The actual "choice" it will provide is limited for most, who will continue to rely on their doctors' advice and who, in any case, often live in cities with only one hospital.   

The influence of  British health care experiments on the thinking at the Ministry of Health and Long Term Care continues.  And that is a scary thought, given what the British Conservative-Liberal government is up to.  


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