Ensuring accountability and improving quality are two of the most significant challenges facing health systems around the world. The public release of comparative standardised information on quality in the form of “report cards” represents one suggested solution to these complex problems.¹ Report cards are not new—Florence Nightingale produced a report comparing the mortality rates of London teaching hospitals in 1863²—but nevertheless they have been embraced with great enthusiasm in many developed countries in recent years. In the UK, for example, the introduction of report cards is one of the specific recommendations in a plan to modernise the National Health Service.³

Given this enthusiasm, it is perhaps surprising that we know so little about the uses, benefits, and risks of publicising comparative information. Most of the experience and evidence in this field comes from the USA where report cards have been a prominent feature for the last 15 years. Two papers in this issue of QHC describe the current state of play in the USA and help to develop our understanding of whether and how report cards fulfil the ambitious claims made of them.

It may seem self-evident that the general public should be the primary audience for the “public” release …