This paper presents several hypotheses about why public reporting of performance information in healthcare has not had more impact. Abstracting information from paper-based systems is slow and expensive, impairing the ability to provide timely, accurate information about system performance. Alternatively, the incentives that drive the behaviour of participants in the system may obstruct meaningful change in response to performance information. The delivery of healthcare is a very complex enterprise. This makes creating a set of indicators that is both useful and readily understandable by the general public very difficult. Perhaps the industry should consider the development of composite indicators not unlike those used to report on the macroeconomic performance of regional economies. In this regard, the development of composite indicators for quality of care (using measures of evidence-based protocol adherence) and access (through wait-times measures) is suggested. In conclusion, the paper states that it is too early to judge the efficacy of public reporting of performance information in healthcare; much more development of performance reporting is required.

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