Effects of disclosing inspection scores of health facilities

Health services are highly regulated and targeted for in-depth inspections by government officials in major part of the countries, aiming at the protection of patients from malpractice. In Brazil, the inspection of regulated professions costs approximately 3.3 billion reais (630 million US dollars) annually. Despite the substantial costs, there is lack of evidence on the quality of the public expenditures on regulation of health services. The Brazilian legal framework poses additional challenges to account for policy effectiveness, since professional regulatory bodies may adopt its own inspection strategy. A methodological alternative to deal with the complexity of public policies refers to the adoption of complex systems approach, considering the interaction between agents, the influence of diverse factors, and the possibility of emergence of patterns from bottom-up. Thus, the objective of the study was to present an agent-based model to investigate two inspection strategies applied to health services: one strategy omits inspection scores from patients, whilst the other discloses the inspection scores. The results of the interactions between patients and clinics under different inspection strategies through computational simulation showed that transparency in inspection scores had no significant impact neither on patients' health nor on clinics’ compliance rate. Conclusions drawn in the light of public policy effectiveness indicate the possibility of adaptation of the model to other regulatory environments.