Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
- PMID:15184339
- PMCID: PMC419772
- DOI: 10.1503/cmaj.1040722
Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
Abstract
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Methods: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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.
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Comment in
- The high costs of for-profit care.Woolhandler S, Himmelstein DU.Woolhandler S, et al.CMAJ. 2004 Jun 8;170(12):1814-5. doi: 10.1503/cmaj.1040779.CMAJ. 2004.PMID:15184338Free PMC article.No abstract available.
- Care at for-profit hospitals.Richman VV.Richman VV.CMAJ. 2004 Nov 9;171(10):1151; author reply 1151, 1154. doi: 10.1503/cmaj.1041047.CMAJ. 2004.PMID:15534295Free PMC article.No abstract available.
- Care at for-profit hospitals.Nuttley WM.Nuttley WM.CMAJ. 2004 Nov 9;171(10):1151; author reply 1151, 1154. doi: 10.1503/cmaj.1041049.CMAJ. 2004.PMID:15534296Free PMC article.No abstract available.
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