More Patients Die in For-Profit Hospitals

by John Della Contrada

The purpose of the study -- which analyzed treatment of 38 million patients -- was to help inform Canadians as they begin a national debate over switching to a for-profit health care system.

"Most of the debate so far has focused on economics," said P. J. Devereaux, M.D., research fellow at McMaster University in Hamilton, Ontario. "The emphasis has been on determining if for-profit hospitals can contain costs and run more efficiently... what has been missing from this debate is how expansion of private for-profit hospitals would affect patients," he said.

Private not-for-profit hospitals are owned by religious organizations, communities, regional health authorities or hospital boards. For-profit hospitals are owned by shareholders or investors.

Results showed that for-profit hospitals were associated with significantly higher mortality.

"Although the relative increase in risk amounts to 2 percent in our analysis, which may seem small, the absolute number is frightening," said University at Buffalo's Holger Schunemann, M.D., one of the authors on the study.

The researchers point to pressure to achieve the expected profit for investors as the probable cause of this increase in mortality.

"Heads of for-profit hospitals are rewarded based on meeting or surpassing the profit margin," said Devereaux. "Senior administrators get big salaries, and for-profit organizations also have to pay taxes. When reimbursement comes from the same source as not-for-profits, such as from Medicare, for-profits are faced with trying to achieve the same outcomes while having less to spend on patient care.

"These issues raise concerns that the profit motive causes hospitals to limit care in ways that affect patient outcomes, and our findings suggest such concerns are justified."

Devereaux pointed in particular to the finding that for-profit hospitals had fewer highly skilled personnel per "risk-adjusted" bed, a statistic strongly associated with hospital mortality rates. Differences in mortality rates between for-profit and not-for-profit decreased when researchers adjusted statistically for staffing levels, he said.

"All data are derived from U.S. studies," said Schunemann. "The results are directly applicable to the American public. Being treated in a private for-profit hospital puts patients at increased risk, and the number of private for-profit hospitals in the U.S. is growing."

The study appeaed in the May 28 issue of the Canadian Medical Association Journal.