PT  - JOURNAL ARTICLE
AU  - P.J. Devereaux
AU  - Diane Heels-Ansdell
AU  - Christina Lacchetti
AU  - Ted Haines
AU  - Karen E.A. Burns
AU  - Deborah J. Cook
AU  - Nikila Ravindran
AU  - S.D. Walter
AU  - Heather McDonald
AU  - Samuel B. Stone
AU  - Rakesh Patel
AU  - Mohit Bhandari
AU  - Holger J. Schünemann
AU  - Peter T.-L. Choi
AU  - Ahmed M. Bayoumi
AU  - John N. Lavis
AU  - Terrence Sullivan
AU  - Greg Stoddart
AU  - Gordon H. Guyatt
TI  - Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
AID  - 10.1503/cmaj.1040722
DP  - 2004 Jun 08
TA  - Canadian Medical Association Journal
PG  - 1817--1824
VI  - 170
IP  - 12
4099  - http://www.cmaj.ca/content/170/12/1817.short
4100  - http://www.cmaj.ca/content/170/12/1817.full
SO  - CMAJ2004 Jun 08; 170
AB  - Background: It 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. Methods: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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. Results: Eight 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). Interpretation: Private 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.