ABSTRACT
The expansion of hospital performance comparisons and their influence on hospital care for the period of 1945–2016 are the topic of this chapter. Important preconditions for the rise of performance comparisons are explored. These include the advent of health insurance in the United States, the federal government’s health care policies, and the introduction of diagnosis-related groups (DRGs) as the basis for hospital reimbursement, which pay a predefined sum for a specific diagnosis and treatment. These developments tied hospital cost and quality closely together and added new observers interested in reviewing hospitals’ performance. Moreover, a host of new indicators and measures, especially those focused on ostensibly unambiguous health care outcomes, were developed. However, they remain controversial because they did not solve the issues concerning the attribution of success in health care and because they are not instructive as decision programs for physicians. Equally disputed were further forms of performance control that were initiated in the 1980s with the rise of health maintenance organizations. These managed care techniques not only review physicians’ decision but actively oversee them, for example, by requiring prior approval for procedures by third-party payers. Moreover, hospital physicians also became more accountable to the scientific elite of their profession and the medical hierarchy of the hospital, as exemplified by the increased role of clinical practice guidelines. Finally, the chapter considers the practice of publicizing hospitals’ performance in the form of rankings or rating and why they have not accomplished the expected benefits.
