Hospital ownership and quality of care: what explains the different results in the literature?

Abstract

This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The 'true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time.

Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil

“…Ainda que não tenham sido explorados outros aspectos de natureza organizacional e financeira tidos como relacionados à qualidade, tais como o contexto e cultura institucional, diferenças regionais e o grau de atuação de mercados privados 25 , entre as características estruturais dos hospitais estudados o desempenho relativamente melhor de hospitais de pequeno porte se destacou, achado que parece mais associado ao perfil menos complexo dos casos, indicado tanto pelas variáveis descritivas do risco do paciente como pelo menor uso de UTI, o que também pode se relacionar à menor disponibilidade desses leitos.…”

“…Por fim, há a limitação quanto ao recorte do estudo, visto que aspectos organizacionais e financeiros dos hospitais e do contexto que poderiam contribuir para melhor compreensão dos resultados não fizeram parte do escopo, destacando-se: a disponibilidade de profissionais de saúde e equipamentos por paciente; a rotatividade de leitos; os incentivos ou pressões financeiras; as características de mercado; o investimento em atividades voltadas à qualidade; o contexto e a cultura institucional; as diferenças regionais; entre outros 4,24,25 .…”

China's Health Reform Update

“…Because there are minimal, if any, gatekeepers to services in hospitals, it is common for tertiary hospitals to provide basic outpatient services on top of broader research and advanced medical services. This expansive service provision, combined with greater public trust in larger public hospitals over local health clinics (4,16,17,60,87), overburdened public hospitals, creating significant systemic inefficiencies. At the same time as China's economy transitioned away from the planned economy beginning in the early 1980s, the government retreated from the financing of services throughout the 1990s (Figure 1) (84).…”

Cost versus control: Understanding ownership through outsourcing in hospitals

“…2 Sloan (2000) summarizes the particular effects present in the hospital context due to moral hazard and the consumer's asymmetric information. This literature is particularly concerned with the effect of ownership on the provision of service quality (Sloan et al 2001, Picone et al 2002, Eggleston et al 2008, but also on the role of competition (Duggan 2002), managerial compensation (Ballou and Weisbrod 2003), and these characteristics combined with the question of what drives nonprofit behavior, more generally (Deneffe and Masson 2002, Horwitz and Nichols 2009, Chang and Jacobson 2011, McClellan and Staiger 2000. The paper most related to ours, both in context and approach, is Chang and Jacobson (2011), which looks at hospitals in California and also uses seismic retrofitting as an exogenous cost shock.…”