RT Journal Article SR Electronic T1 Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis JF Canadian Medical Association Journal JO CMAJ FD Canadian Medical Association SP 1817 OP 1824 DO 10.1503/cmaj.1040722 VO 170 IS 12 A1 P.J. Devereaux A1 Diane Heels-Ansdell A1 Christina Lacchetti A1 Ted Haines A1 Karen E.A. Burns A1 Deborah J. Cook A1 Nikila Ravindran A1 S.D. Walter A1 Heather McDonald A1 Samuel B. Stone A1 Rakesh Patel A1 Mohit Bhandari A1 Holger J. Schünemann A1 Peter T.-L. Choi A1 Ahmed M. Bayoumi A1 John N. Lavis A1 Terrence Sullivan A1 Greg Stoddart A1 Gordon H. Guyatt YR 2004 UL http://www.cmaj.ca/content/170/12/1817.abstract 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 Methods: We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals.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.