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We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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