• P J Devereaux, Diane Heels-Ansdell, Christina Lacchetti, Ted Haines, Karen E A Burns, Deborah J Cook, Nikila Ravindran, S D Walter, Heather McDonald, Samuel B Stone, Rakesh Patel, Mohit Bhandari, Holger J Schünemann, Peter T-L Choi, Ahmed M Bayoumi, John N Lavis, Terrence Sullivan, Greg Stoddart, and Gordon H Guyatt.
• Department of Medicine, McMaster University, Hamilton, ON.philipj@mcmaster.ca
• CMAJ. 2004 Jun 8; 170 (12): 1817-24.

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private for-profit and private not-for-profit hospitals.MethodsWe used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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

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