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<p>We exploit the introduction of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to examine whether mandatory patient-experience reporting alters U.S. hospitals’ resource allocation. Using a difference-in-differences design, we find that hospitals subject to the mandate reduce the share of spending devoted to clinical care, implying a 0.6% decline in clinical spending share. This equates to approximately $1 million annually for a mid-sized hospital. Consistent with multitasking theory, greater emphasis on patient experience induces a reallocation of financial resources and managerial attention away from clinical care. Clinical spending per discharge also declines, indicating reduced clinical intensity. Treated hospitals subsequently exhibit worse inpatient mortality outcomes, 0.15–0.25 percentage points relative to a 2.3% baseline rate, representing a 7%–10% deterioration compared to unaffected hospitals. Mediation and cross-sectional analyses link resource reallocation to inpatient mortality. These effects emerge prior to public disclosure, suggesting responses to measurement and anticipated reporting.</p>

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Mandatory patient surveys and hospital resource allocation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月3日

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  • Vedran Capkun,
  • Davide Cianciaruso,
  • Kirti Sinha

摘要

We exploit the introduction of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to examine whether mandatory patient-experience reporting alters U.S. hospitals’ resource allocation. Using a difference-in-differences design, we find that hospitals subject to the mandate reduce the share of spending devoted to clinical care, implying a 0.6% decline in clinical spending share. This equates to approximately $1 million annually for a mid-sized hospital. Consistent with multitasking theory, greater emphasis on patient experience induces a reallocation of financial resources and managerial attention away from clinical care. Clinical spending per discharge also declines, indicating reduced clinical intensity. Treated hospitals subsequently exhibit worse inpatient mortality outcomes, 0.15–0.25 percentage points relative to a 2.3% baseline rate, representing a 7%–10% deterioration compared to unaffected hospitals. Mediation and cross-sectional analyses link resource reallocation to inpatient mortality. These effects emerge prior to public disclosure, suggesting responses to measurement and anticipated reporting.