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date: 23 March 2019

Abstract and Keywords

Health care organizations are under increasing pressure to account for their performance to outside constituencies. This chapter reviews the background, nature, and consequences of organized efforts to enhance transparency in health care. Market reforms and quality concerns create mounting demands for public transparency, but health care quality is difficult to assess in a way that is both fair and accessible to a general audience. Public quality reporting has not been shown to improve quality of care, and there is a risk that it produces nominal rather than effective transparency. Especially when combined with economic incentives, transparency regimes tend to breed gaming, which is repeatedly ignored by systems designers. Health professionals typically react negatively, even if they also participate in and derive some benefits from transparency efforts. Future research needs to explore systematically the strategies that professionals, patients, and organizations engage in when creating and receiving public quality information.

Keywords: transparency, technologies of transparency, new public management, health care quality, public quality reporting, quality measurement, health care professionals, professional autonomy

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