Does the Ownership of the Admitting Hospital Make a Difference?

Frank Allen Sloan · Justin G. Trogdon · Lesley H. Curtis · Kevin Alan Schulman

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Healthcare Policy and Management Healthcare Quality and Management Acute Myocardial Infarction Research

Abstract

BACKGROUND: Concerns have been expressed about quality of for-profit hospitals and their use of expensive technologies. OBJECTIVE: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in the use of low- and high-tech services for AMI among for-profit, public, and private nonprofit hospitals. STUDY DESIGN, SETTING, AND PATIENTS: Cooperative Cardiovascular Project data for 129,092 Medicare patients admitted for AMI from 1994 to 1995. MAIN OUTCOME MEASURES: Mortality at 30 days and 1 year postadmission; use of aspirin, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers at discharge, thrombolytic therapy, catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft (CABG) compared by ownership. RESULTS: Mortality rates at 30 days and at 1 year at for-profit hospitals were no different from those at public and private nonprofit hospitals. Without patient illness variables, nonprofit hospitals had lower mortality rates at 30 days (relative risk [RR], 0.95; 95% confidence interval [CI], 0.91-0.99) and at 1 year (RR, 0.96; 95% CI, 0.93-0.99) than did for-profit hospitals, but there was no difference in mortality between public and for-profit hospitals. Beneficiaries at nonprofit hospitals were more likely to receive aspirin (RR, 1.04; 95% CI, 1.03-1.05) and ACE inhibitors (RR, 1.05; 95% CI, 1.02-1.08) than at for-profit hospitals, but had lower rates of PTCA (RR, 0.91; 95% CI, 0.86-0.96) and CABG (RR, 0.93; 95% CI, 0.86-1.00). CONCLUSIONS: Although outcomes did not vary by ownership, for-profit hospitals were more likely to use expensive, high-tech procedures. This pattern appears to be the result of for-profit hospitals' propensity to locate in areas with demand for high-tech care for AMI.

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References

1997The Proper Scope of Government: Theory and an Application to Prisons 1998The Dartmouth Atlas of Health Care 1980The New Medical-Industrial Complex 1988Everything for Sale: The Virtues and Limits of Markets 1999Effects of Admission to a Teaching Hospital on the Cost and Quality of Care for Medicare Beneficiaries 2001Hospital ownership and cost and quality of care: is there a dime’s worth of difference?1988The Effects of Regulation, Competition, and Ownership on Mortality Rates among Hospital Inpatients 2000Chapter 21 Not-for-profit ownership and hospital behavior

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