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

• Published in: Canadian Medical Association journal 2004-06, Vol.170 (12), p.1817-1824
• Main Authors: 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, Schunemann, Holger J, Choi, Peter T.-L, Bayoumi, Ahmed M, Lavis, John N, Sullivan, Terrence, Stoddart, Greg, Guyatt, Gordon H
• Format: Article
• Language: English
• Subjects: Canada; Costs; Evaluation; Finance; Health care; Hospitals, Proprietary - economics; Hospitals, Voluntary - economics; Humans; Insurance, Health, Reimbursement; Medicare; Private medical care; Review; Systematic review; United States
• ISSN: 0008-4409; 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.1040722

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. We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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. 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). 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.