BACKGROUNDER:
Private For-Profit Hospitals Have Higher Death Rates
CanadaÕs health care debate involves two critical aspects: who pays for health care, and who delivers health care.
Currently, physician and hospital services in Canada are publicly funded Ñ we pay through our taxes.
Other aspects of health care, including drugs and home care, have mixed systems of public and private funding.
On the delivery side, while many Canadians think our hospitals are publicly owned and admininstered,
they are actually private not-for-profit institutions. They are owned and managed by communities,
religious institutions, district health councils, or their hospital boards.
The delivery-side debate is whether we should switch some of our hospital care,
and other health care delivery, from private not-for-profit to private for-profit.
Ideally, this decision is made on the basis of evidence about how well private for-profit hospitals
are likely to work in comparison to our current private not-for-profit hospitals. Research about how
well private for-profit and private not-for-profit hospitals have worked in other constituencies that
have tried both approaches will help us in our decision. One crucial issue is the quality of health
care in private for-profit and private not-for-profit hospitals, and the impact of that health
care on death rates.
In the past, when private not-for-profit advocates have pointed out research studies suggesting an
increase in death rates in private for-profit hospitals, advocates of moving to private for-profit
delivery have pointed out other studies that failed to show differences in death rates.
To avoid selective presentation of research evidence, a review and summary of all the available
evidence would more completely inform the debate.
In the last 15 years, medical researchers have developed and refined a new methodology for the
scientific summary of information bearing on a specific health question. In this case, the
question is: "What is the relative impact of private for-profit versus private not-for-profit
hospitals on death rates". The method involves:
- developing explicit criteria for deciding whether a study is eligible;
- conducting a comprehensive search to identify all relevant studies;
- applying the eligibility criteria to potentially eligible studies in an unbiased manner;
- examining the quality of the eligible studies;
- conducting a rigorous statistical analysis of the data from the studies that ultimately prove eligible
and of adequate quality.
An internationally acclaimed research team at McMaster University has conducted a rigorous systematic
review of studies comparing private for-profit and private not-for-profit hospitals. Their report,
"A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and
private not-for-profit hospitals," was published in May 28/02's Canadian Medical Association Journal .
The team identified over 8,000 potentially eligible articles, of which over 800 passed an initial
eligibility screen. Two reviewers examined these articles with the results blacked out to avoid bias
in selection. Fifteen studies including over 26,000 hospitals and 38 million patients passed this
second round of scrutiny.
In the studies of adult populations, private for-profit hospitals were associated with a statistically
significant increase in the risk of death. The results are plausible, because for-profit providers
typically must achieve a 10% to 15% profit margin. In addition, they must pay taxes and may contend
with cost pressures associated with large reimbursement packages for senior administrators that private
not-for-profit institutions do not face. These represent resources of funding that private not-for-profit
institutions can devote to patient care. The study results suggest that to ensure profits, private
for-profit hospitals use fewer trained personnel such as board certified nurses and pharmacists.
This is one important mechanism underlying the increased death rates in private for-profit institutions.
The study's findings suggest if Canada were to convert all hospitals to private for-profit institutions,
the increased number of deaths that would result each year (over 2,000) is in the range of how many
Canadians die each year from colorectal cancer, motor vehicle accidents, or suicide. The study provides a
compelling argument to halt the move toward private for-profit provision of health care.
Contact:
Ethel Meade, Co-Chair, OCSCO - 416-785-8570
Gisela Côté, Manager of Communications, OCSCO - 416-785-8570
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