Every year public and private-sector employers, and a majority of American citizens, make decisions on participation in health care plans. For the most part, they decide on the basis of just two factors: cost and scope of services. But health plans, like health providers, actually vary on the basis of quality: how well they deliver care; how well they help people stay healthy; how well they help people recover from illnesses; how well they support people with chronic illnesses; and how well they adjust to the changing needs of patients. Without reliable and widely disseminated information on the quality of care provided by health plans, it is no wonder so many purchasers focus excessively on cost, while so many plans seem to focus excessively on holding down costs at the expense of quality.

Fortunately, help is on the way. Spurred on by many health plan sponsors, with an extra push from federal and state elected officials alarmed by anecdotes about low-quality care, there is now a national movement to create Health Plan Report Cards that let consumers know how well specific plans have performed in producing key health outcomes for their participants. The National Committee for Quality Assurance, a private agency, has already developed and implemented one report card, though its utility has been limited by its focus on preventive health measures and the relatively small group of health plans that have agreed to supply the relevant information. Meanwhile, the Foundation for Accountability (FACCT), another private entity, has just released a "template" for Health Plan Report Cards that covers all five of the health outcomes consumers most need to know about -- satisfaction with care, prevention, recovery from illness, support in chronic illness, and adaptibility to changing needs. If every purchaser -- employer or individual -- had access to this kind of information, then health plans would compete for business on the basis of quality as well as cost and scope of services.

Government -- federal and state -- can best promote Health Care Report Cards not by issuing them, but by demanding them. By using their leverage as major purchasers of health care for their employees, government can push heath plans to make public the necessary information so that private entities can use them to produce report cards and purchasers can use them to encourage quality-based competition. Legislation (S.795) sponsored by Sens. Joe Lieberman (D-CT), John Breaux (D-LA), John Chafee (R-RI), and James Jeffords (R-VT) would do exactly that on behalf of the federal government. State lawmakers should follow suit. In addition, government should require health plans to supply health outcome information so that purchasers can create their own report cards. Ultimately, we believe quality measurement should extend to health providers -- hospitals and doctors -- as well as to insurers, creating a true "buyer's market" in health care.