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Invited Commentary
July 22, 2013

To Bring Consumers to the Table, Simplify the Review

Author Affiliations
  • 1California HealthCare Foundation, Oakland
JAMA Intern Med. 2013;173(14):1358. doi:10.1001/jamainternmed.2013.7946

In the past decade, a significant push has been made for more transparency in quality reporting, including many new transparency provisions in the Patient Protection and Affordable Care Act, also known as “Obamacare.” It is hard to argue with the concept. Transparency works in other fields. For example, after Los Angeles County required restaurants to publicly display a letter-grade card in their front windows with an A, B, or C, corresponding to the results of their latest health inspection, the county witnessed a 20% drop in hospitalizations for food-related illnesses.1 The dramatic improvement was attributed to a change in the behavior of restaurant owners and operators, as well as their customers. Public reporting provided a strong incentive for restaurant operators to make actual improvements in hygiene—less than an A grade was seen as a disaster for business. Consumers were likely also voting with their feet—decreasing their selection of lower-ranking restaurants. Changes in the quality of the supply and the quantity of the demand achieved a dramatic outcome.

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