Published on in Vol 14, No 3 (2012): May-Jun

Consistently Increasing Numbers of Online Ratings of Healthcare in England

Consistently Increasing Numbers of Online Ratings of Healthcare in England

Consistently Increasing Numbers of Online Ratings of Healthcare in England

Authors of this article:

Felix Greaves1 ;   Christopher Millett1

Letter to the Editor

Department of Primary Care and Public Health, Imperial College London, London, United Kingdom

Corresponding Author:

Felix Greaves, BM, BCh, MPH, MBA

Department of Primary Care and Public Health

Imperial College London

Reynolds Building, Charing Cross Campus

London, W6 8RP

United Kingdom

Phone: 44 7866 551172

Fax:44 207 5940584


In a recent JMIR paper, Gao and colleagues demonstrated the growing number of internet-based ratings of physicians on a commercially-owned website in the USA [1].

In England, in keeping with our National Health Service, we have a government run website that allows patients to rate and comment on their care online in a similar way, but at the level of healthcare provider organisations rather than individuals. The website is called NHS Choices [2]. Gao suggests that their results demonstrate a positive correlation between online ratings and physician quality. We have similarly demonstrated how better online ratings at the organisational level are associated with better clinical outcomes [3], and patient experience measured by surveys [4] in England.

In a new analysis to allow comparison with Gao’s results, we looked at the number of ratings of hospitals posted on the NHS Choices website over the period since it started (August 2008) to the end of 2011. There were 20,996 ratings of hospitals over the 40 month period, fewer than in the US. We found a more gradual, linear increase in ratings in England (Figure 1) compared with the accelerating growth in ratings seen on commercial sites in the US [1]. We are not sure why the frequency of ratings is stable in England, but not increasing at the same rate as in the US. This may be because marketing budgets are lower for an English government run service compared to the more commercial advertising approach of US websites, leading to lower awareness of the websites in England. Alternatively, patients in England may be less culturally familiar with the concept of provider choice in healthcare, as the ability to choose between providers has only been introduced relatively recently in the English NHS while it may be a cultural norm in the US. This might result in English patients being less inclined to rate their care. We hope this adds to the work of our American colleagues, and demonstrates that the increasing number of online ratings of healthcare is an international phenomenon, even if England is perhaps at an earlier stage on the curve than the US.

Figure 1. Cumulative number of online ratings of hospitals in England on the NHS Choices website.
View this figure
  1. Gao GG, McCullough JS, Agarwal R, Jha AK. A changing landscape of physician quality reporting: analysis of patients' online ratings of their physicians over a 5-year period. J Med Internet Res 2012;14(1):e38 [FREE Full text] [CrossRef] [Medline]
  2. Department of Health. NHS Choices website. 2012.   URL: [accessed 2012-05-01] [WebCite Cache]
  3. Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, et al. Associations between Web-based patient ratings and objective measures of hospital quality. Arch Intern Med 2012 Mar 12;172(5):435-436. [CrossRef] [Medline]
  4. Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, et al. Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. BMJ Qual Saf 2012 Jul;21(7):600-605. [CrossRef] [Medline]

Edited by G Eysenbach; submitted 04.05.12; peer-reviewed by G Gao, S Patel; comments to author 14.06.12; revised version received 14.06.12; accepted 27.06.12; published 29.06.12


©Felix Greaves, Christopher Millett. Originally published in the Journal of Medical Internet Research (, 29.06.2012.

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