http://bmj.com/cgi/content/full/324/7350/1351
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 Collections under
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Janice Hopkins Tanne
Patients in for-profit hospitals in the United States are more likely to die than those in non-profit hospitals, a new systematic review and meta-analysis says. The study, by researchers at McMaster University in Hamilton, Ontario, and the University of Buffalo, New York, has been published in the Canadian Medical Association Journal (2002;166:1399-406).
Besides the implications for the United States, the study fuels debate in Canada over whether private, for-profit hospitals should be allowed to enter the marketplace in an overhaul of Canada's national health insurance plan. The Commission on the Future of Health Care in Canada, headed by Roy Romanov, former Saskatchewan premier, will make its final report in November.
Letting for-profit hospitals into Canada "is not a good idea," said Dr PJ Devereaux, a cardiologist at McMaster University and the study's lead author. "We could expect increased mortality."
The study compared mortality in private, for-profit and private, non-profit hospitals in the United States between 1982 and 1995. It reviewed 15 observational studies that included 26000 hospitals and 38 million patients. Some hospitals featured in more than one study. Most patients were covered by Medicare, the government insurance for elderly people.
Patients treated at for-profit hospitals had a 2% increased risk of death
(relative risk 1.020, 95% confidence interval 1.003 to 1.038), the
report says. In Canada, that would mean 2200 extra deaths per year
about
the same number as die from suicide or colon cancer or in traffic
crashes.
In the United States, said co-author Dr Holger Schönemann, assistant professor at the University of Buffalo, a 2% increased risk means that 14000 people die each year at for-profit hospitals who would have lived if treated at non-profit hospitals.
About 13% of the 5810 hospitals in the United States are private, for-profit hospitals, according to the American Hospital Association. They are often part of chains. Many other US hospitals are private, non-profit hospitals, run by charitable, community, or religious organisations, as are about 95% of Canadian hospitals.
The higher death rate at for-profit hospitals occurs for two reasons, Dr Devereaux said: "Shareholders expect a 10% to 15% return and the hospitals have to pay taxes. Funding is fixed [from Medicare and other schemes in the United States and from national health insurance in Canada], so they cut corners on skills. It would be no different in Canada or Britain. If Canada opened its doors to private, for-profit hospitals, they would be the same US chains that generated the data included in our study."
In an editorial comment (CMAJ 2002;166:1416-7)[Full
Text], Dr C David Naylor, dean of the faculty
of medicine at the University of Toronto, wrote: "Does anyone still
want to contract out large segments of our publicly financed health
care system to for-profit US hospital chains after reading this
article? I hope not."
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Collections under
which this article appears:Organization
of health care Patient
safety / Clinical risk / Medical error |
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