BACKGROUND: It has been shown that patients cared for at private for-profit hospitals have higher risk-adjusted mortality rates than those cared for at private not-for-profit hospitals. Uncertainty remains, however, about the economic implications of these forms of health care delivery. Since some policy-makers might still consider for-profit health care if expenditure savings were sufficiently large, we undertook a systematic review and meta-analysis to compare payments for care at private for-profit and private not-for-profit hospitals. METHODS: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals. We masked the study results before teams of 2 reviewers independently evaluated the eligibility of all studies. We confirmed data or obtained additional data from all but 1 author. For each study, we calculated the payments for care at private for-profit hospitals relative to private not-for-profit hospitals and pooled the results using a random effects model. RESULTS: Eight observational studies, involving more than 350 000 patients altogether and a median of 324 hospitals each, fulfilled our eligibility criteria. In 5 of 6 studies showing higher payments for care at private for-profit hospitals, the difference was statistically significant; in 1 of 2 studies showing higher payments for care at private not-for-profit hospitals, the difference was statistically significant. The pooled estimate demonstrated that private for-profit hospitals were associated with higher payments for care (relative payments for care 1.19, 95% confidence interval 1.07-1.33, p = 0.001). INTERPRETATION: Private for-profit hospitals result in higher payments for care than private not-for-profit hospitals. Evidence strongly supports a policy of not-for-profit health care delivery at the hospital level.
BACKGROUND: It has been shown that patients cared for at private for-profit hospitals have higher risk-adjusted mortality rates than those cared for at private not-for-profit hospitals. Uncertainty remains, however, about the economic implications of these forms of health care delivery. Since some policy-makers might still consider for-profit health care if expenditure savings were sufficiently large, we undertook a systematic review and meta-analysis to compare payments for care at private for-profit and private not-for-profit hospitals. METHODS: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals. We masked the study results before teams of 2 reviewers independently evaluated the eligibility of all studies. We confirmed data or obtained additional data from all but 1 author. For each study, we calculated the payments for care at private for-profit hospitals relative to private not-for-profit hospitals and pooled the results using a random effects model. RESULTS: Eight observational studies, involving more than 350 000 patients altogether and a median of 324 hospitals each, fulfilled our eligibility criteria. In 5 of 6 studies showing higher payments for care at private for-profit hospitals, the difference was statistically significant; in 1 of 2 studies showing higher payments for care at private not-for-profit hospitals, the difference was statistically significant. The pooled estimate demonstrated that private for-profit hospitals were associated with higher payments for care (relative payments for care 1.19, 95% confidence interval 1.07-1.33, p = 0.001). INTERPRETATION: Private for-profit hospitals result in higher payments for care than private not-for-profit hospitals. Evidence strongly supports a policy of not-for-profit health care delivery at the hospital level.
Authors: P J Devereaux; Peter T L Choi; Christina Lacchetti; Bruce Weaver; Holger J Schünemann; Ted Haines; John N Lavis; Brydon J B Grant; David R S Haslam; Mohit Bhandari; Terrence Sullivan; Deborah J Cook; Stephen D Walter; Maureen Meade; Humaira Khan; Neera Bhatnagar; Gordon H Guyatt Journal: CMAJ Date: 2002-05-28 Impact factor: 8.262
Authors: P J Devereaux; Holger J Schünemann; Nikila Ravindran; Mohit Bhandari; Amit X Garg; Peter T-L Choi; Brydon J B Grant; Ted Haines; Christina Lacchetti; Bruce Weaver; John N Lavis; Deborah J Cook; David R S Haslam; Terrence Sullivan; Gordon H Guyatt Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: Vikram R Comondore; P J Devereaux; Qi Zhou; Samuel B Stone; Jason W Busse; Nikila C Ravindran; Karen E Burns; Ted Haines; Bernadette Stringer; Deborah J Cook; Stephen D Walter; Terrence Sullivan; Otavio Berwanger; Mohit Bhandari; Sarfaraz Banglawala; John N Lavis; Brad Petrisor; Holger Schünemann; Katie Walsh; Neera Bhatnagar; Gordon H Guyatt Journal: BMJ Date: 2009-08-04
Authors: Gordon H Guyatt; Pj Devereaux; Joel Lexchin; Samuel B Stone; Armine Yalnizyan; David Himmelstein; Steffie Woolhandler; Qi Zhou; Laurie J Goldsmith; Deborah J Cook; Ted Haines; Christina Lacchetti; John N Lavis; Terrence Sullivan; Ed Mills; Shelley Kraus; Neera Bhatnagar Journal: Open Med Date: 2007-04-14