For nursing homes at least, patients do not seem to have much choice. According to an article by Grabowski and Town:
The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets…The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance.
In general, there are many reasons why patients do not respond to provider report cards. It could be the case that the provider is a monopoly, and thus the patient has little choice of providers. Alternatively, patients may not be aware of the quality metrics. One would thing that high quality providers, however, would spend money advertising their high quality ratings to make patients aware of their services. In other cases, the patients may not be the ones directing care choices. Providers may be the ones who are the de facto selectors of care.
Patients could also not believe that the CMS quality ratings are very useful. They may prefer other sources of information on medical quality such as their friends, relatives, or physicians. Thus, it may be the physician who actually chooses to which nursing home the patient will go. If the physician has incentives to sent the beneficiary to nursing homes in the network or simply does not wish to spend the time analyzing nursing home quality, then patients may be less likely to be allocated to high quality nursing home.
- Grabowski, D. C. and Town, R. J. (2011), Does Information Matter? Competition, Quality, and the Impact of Nursing Home Report Cards. Health Services Research. doi: 10.1111/j.1475-6773.2011.01298.x