Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis

Devereaux, P. J.; Heels-Ansdell, Diane; Lacchetti, Christina; Haines, Ted; Burns, Karen E. A.; Cook, Deborah J.; Ravindran, Nikila; Walter, S. D.; McDonald, Heather; Stone, Samuel B.; Patel, Rakesh; Bhandari, Mohit; Schünemann, Holger J.; Choi, Peter T. L.; Bayoumi, Ahmed M.; Lavis, John N.; Sullivan, Terrence; Stoddart, Greg; Guyatt, Gordon H.
June 2004
CMAJ: Canadian Medical Association Journal;6/8/2004, Vol. 170 Issue 12, p1817
Academic Journal
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. Uncer-tainty 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 Methods: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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 ef-fects model. Results: Eight observational studies, involving more than 350 000 patients altogether and a median of 324 hospitals each, ful-filled 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 differ-ence was statistically significant. The pooled estimate demon-strated 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 pay-ments 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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