Raisa Deber states that “quality differences between for-profit and not-for-profit organizations appear to be less pronounced when clinicians are able to influence the care they give without direct pressures to balance their clinical judgement against shareholder returns.” This may be the case. However, our systematic review1 demonstrated that private for-profit hospitals employed less highly skilled health professionals, and there is a demonstrable association between health professionals' skill level and patient mortality. Therefore, even if the private for-profit hospitals do not pressure their health professionals to balance their clinical judgement against the return to shareholders, the lower skill level provides one explanation for the largely consistent higher mortality rates in private for-profit hospitals.
P.J. Devereaux Maureen Meade Gordon H. Guyatt Department of Medicine McMaster University Hamilton, Ont. Peter T.L. Choi Christina Lacchetti Bruce Weaver John N. Lavis Brydon J.B. Grant Clinical Epidemiology and Biostatistics McMaster University Hamilton, Ont. Holger J. Schünemann Department of Medicine University at Buffalo Buffalo, NY Terrence Sullivan Department of Health Policy Management and Evaluation University of Toronto Toronto, Ont.
Reference
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