Health Care Quality Reporting: A Failed Form of Mandated Disclosure?

Abstract

The recently published book by Professors Omri Ben-Shahar and Carl E. Schneider, More Than You Wanted to Know: The Failure of Mandated Disclosure, imparts valuable lessons and offers food for thought for "disclosurites" of all sorts. The book's sensible arguments and voluminous evidence cutting across a broad range of regulatory areas should lead readers to question the advisability of mandated disclosure as a regulatory strategy. At the same time, however, the broad sweep of their work constrains their ability to offer comprehensive assessments of the advisability of particular disclosure policies, leaving readers to wonder whether there are exceptions to the authors' general claim, and if so, what form they might take. In this essay, I explore the possibility that quality reporting might be just such an exception. While quality reporting suffers from many of the problems that Ben-Shahar and Schneider have identified, evidence suggests quality reporting can make a difference. But assessing the net impact of quality reporting is no easy task. The policy objectives underlying governmental quality reporting initiatives are significantly broader than the goal at the heart of Ben-Shahar's and Schneider's analysis, complicating efforts to assess the initiatives' success. The initiatives' costs are also challenging to evaluate, in part because they support not just public reporting, but also other benefit-producing activities. After discussing these and other complexities that highlight the limits of Ben-Shahar's and Schneider's analysis, the essay calls for the development of a framework that lays out key characteristics of disclosure mandates and the environments in which they operate, so that we can develop a better understanding of the characteristics associated with mandate success.