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Book Review   |    
Grading Health Care: The Science and Art of Developing Consumer Scorecards
Cheryl A. Ouimet, M.S.W.
Psychiatric Services 1999; doi:
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edited by Pamela P. Hanes and Merwyn R. Greenlick; Jossey-Bass Publishers, San Francisco, 1998, 166 pages, $39.95

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If we are to grade health care in ways that are meaningful to consumers, we need to rely on measures that are relevant to them and tailored to address their specific health care concerns. This book describes the work of the Oregon Consumer Scorecard Consortium, whose goal was to develop a scorecard that would help consumers select a health plan. The book illustrates the challenges that arise in constructing a scorecard that meets individual consumers' needs for health care information while also being responsive to the needs of more powerful stakeholders involved in the scorecard process.

The consortium included consumers, researchers, policy makers, and representatives from health-insuring organizations, and the diverse interests of the group are reflected in this book. As a result, Grading Health Care goes beyond its stated purpose of including consumers' perspectives in developing scorecards to providing a broader-based discussion of the political, economic, and technical issues that influence the designing of consumer scorecards.

Individual consumers and large-volume purchasers of health plans seek information about the quality of health care from different sources. Population-based performance measures and administrative policies or structures that health-insuring organizations and accrediting bodies generally rely on to assess the quality of care are not relevant to individual consumers. They prefer to get information about health care plans from others with similar needs. To obtain consumers' perspectives, the consortium relied on focus groups and literature reviews. These activities revealed that consumers consider patient satisfaction surveys one of the most helpful sources of information about service quality. Consumers also reported their preference for ready access to a knowledgeable person who can help interpret scorecard results.

Constructing a consumer scorecard is both an expensive and a time-intensive process. Consequently, the editors report, the consortium's original focus on developing a scorecard for individual consumers shifted over time to meeting the information needs of large-volume purchasers of health plans. The consortium's experience provides evidence that preferences for the type of information that consumers want will continue to be overshadowed by the interests of more powerful stakeholders involved in the process.

What can be done to address this inevitable problem? Based on the guiding principle that consumers prefer information from others with similar needs, the establishment of consumer affairs departments within health care organizations would be one response. Such departments could help organizations construct patient satisfaction surveys that truly reflect consumers' interests as well as help consumers interpret scorecard results. Scorecards can be relevant only if they empower consumers to make informed decisions about their health care; providing information from other consumers is one of the most meaningful ways to achieve this goal.

Although the lessons learned by the Oregon Consumer Scorecard Consortium make an interesting story, the book does not provide specific guidance for designing scorecards for consumers with behavioral health care needs. Specialists in health care policy and research will find this book a useful resource, and one hopes they will be able to avoid some of the pitfalls of scorecard development encountered by those who have gone before them.

Ms. Ouimet is performance improvement coordinator at John Umstead Hospital in Butner, North Carolina.

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