title: 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  We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Medicine, McMaster University, Hamilton, ON.philipj@mcmaster.ca
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Christina
authors.initials: C
authors.lastname: Lacchetti
authors.forename: Ted
authors.initials: T
authors.lastname: Haines
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Nikila
authors.initials: N
authors.lastname: Ravindran
authors.forename: S D
authors.initials: SD
authors.lastname: Walter
authors.forename: Heather
authors.initials: H
authors.lastname: McDonald
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Stone
authors.forename: Rakesh
authors.initials: R
authors.lastname: Patel
authors.forename: Mohit
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authors.lastname: Bhandari
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Peter T-L
authors.initials: PT
authors.lastname: Choi
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.forename: John N
authors.initials: JN
authors.lastname: Lavis
authors.forename: Terrence
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authors.lastname: Sullivan
authors.forename: Greg
authors.initials: G
authors.lastname: Stoddart
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D002170:Canada; D006777:Hospitals, Proprietary / Q000191:economics*; D006788:Hospitals, Voluntary / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D014481:United States