How will we know if we got it right? Aims, benefits, and risks of consumer information initiatives

Initiatives on the part of many groups to provide American consumers with information about the quality of health care may have several goals. Symbolic aims include recognizing consumers, increasing the sense of accountability, providing reassurance about health care quality, and emphasizing quality. Instrumental aims include improving system performance, increasing satisfaction with care and/or plans, and reducing random plan switching. These efforts may have both good effects and bad effects.

The possible positive byproducts of consumer information initiatives are learning about consumer preferences and variations, learning how to help consumers use health plans and providers, changing consumer-provider relationships, and building an infrastructure of consumer-centered intermediaries. Possible bad effects are generating demands that cannot be met, skewing the system to certain consumers' preferences, discouraging consumers from using information, adding another new program that will die, contributing to biased plan selection, and decreasing trust in providers.

Before health care professionals can gather evidence about outcomes signaling success, they must address several major issues. How should high-quality performance be defined and by whom? Whose vision will be embedded in these definitions? Will it be the consumer's vision or the patient's vision that will be maximized? How long will it take before expected consequences occur? A strategy to measure success calls for beginning immediately to develop consensus on outcomes and a "theory of action" specifying the pathways and timing for different players.