Health & Science blog

By Ross Tieman

French news magazine Le Point has published its third annual ranking of the “best” hospitals in France.

The survey raises interesting questions that go beyond whether a patient in Nice would do best to jump on the high-speed train to Lille to get his or her stomach complaint sorted out.

What is the purpose of such rankings, are they an effective barometer of hospital competence, and what effect might they have on the quality of care hospitals provide?

In the US, where U.S. News & World Report has been publishing rankings of hospitals and clinics for 20 years, information like this can shape the medical “market”. Where care is funded by insurers, patients and insurers alike can use them to aid decisions about where to seek treatment according to which establishment delivers the best results, or the most cost-effective treatment. That helps explain why there is an increasing number of rankings competing for the attention of US health-care buyers.

In the UK, where National Health Service patients have been free to choose which hospital to patronise since April 1 2008, rankings of this kind are likely to become of increasing interest to patients. Thus far, “best” lists, seem to be dominated by surveys of patient satisfaction.

The Le Point ranking is also relevant to patients, because in France’s mixed public/private healthcare system, patients have a good deal of freedom in deciding where to seek treatment, in the knowledge that most of the cost will be picked up by their insurers.

So it is relevant, from the consumer perspective, to know that the Centre Hospitalier Régional Universitaire de Lille is reckoned to offer the best overall range of services and treatment outcomes in France, besides waging a diligent campaign to avoid infections caught during treatment.

It is also striking that the top performers in the French system tend to be state-funded regional groups of hospitals centred on a university. And that only two Paris hospitals rank in the top 20, which is dominated by facilities in big regional cities such as Lille, Toulouse, Bordeaux, or even second-tier cities such as Montpellier, which is renowned for its universities and colleges. Five private sector hospitals do make the top 50, however.

Besides the overall ranking, the magazine produces detailed tables of performance for particular operations or specialities, from hip replacements to gynaecology.

How do they decide which is best? The magazine sent surveys to 700 hospitals, and then by special agreement, trawled through 14.1m anonymous patient files in the PMSI database of the national hospitalisation agency, scoring factors from length-of-stay to mortality.

What could be the unintended consequences? Over time, rankings could begin to shape investment and funding decisions. They could also help successful establishments attract the best staff. But there’s a risk – however tiny – that they could also shape medical practice, if tricky cases threaten a place in the rankings.

Like rankings of business schools or independent schools, medical rankings aid service buyers. But as they become more common, their methodologies will rightly become a focus of debate.