Manipulation of outcome data

Doctors may selectively choose the patients they see in order to increase their ratings. This may occur if a patient has a more complex illness or is at a higher risk of complications.

In health systems that require doctors and health facilities to report the outcomes of their results there may be a failure to do so as well.

This has the effect of denying treatment to those who may need it most and putting patients at risk of receiving treatment by an underperforming doctor or health facility.