The Association between For-Profit Hospital Ownership and Increased Medicare Spending

Abstract

Both the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis

“…We were able to contact 9 of the 10 authors and to confirm that 6 of these studies had no measure of variance, 3 grouped private notfor-profit and public not-for-profit hospitals together and the authors either no longer had the data or could not rerun the analyses excluding the public hospitals, and 1 study had data on charges for care and did not have data on payments for care; these 10 studies were excluded from our systematic review (Table 1). [15][16][17][18][19][20][21][22][23][24] All 10 excluded studies found higher payments or charges for care at private forprofit hospitals than at not-for-profit hospitals; in 6 of the 10, the differences were statistically significant. [15][16][17]21,22,24 Table 2 presents the study characteristics and Table 3 the study methodology of the 8 observational studies included in our systematic review.…”

“…[15][16][17][18][19][20][21][22][23][24] All 10 excluded studies found higher payments or charges for care at private forprofit hospitals than at not-for-profit hospitals; in 6 of the 10, the differences were statistically significant. [15][16][17]21,22,24 Table 2 presents the study characteristics and Table 3 the study methodology of the 8 observational studies included in our systematic review. We obtained or confirmed data with the investigators for 7 studies; the sole author of the remaining study had died.…”

“…Our primary meta-analysis demonstrated that private forprofit hospitals were associated with higher payments for care (relative payments for care 1.19 [15][16][17][18][19][20] Five authors were unable to provide the data, 15,16,[18][19][20] and we were unable to contact 1 author. 17 Two publications reported statistically significant higher payments for care in PFP hospitals, 15,16 1 publication reported statistically significant higher payments for care in PFP hospitals for 11 of the 13 DRGs evaluated, 17 1 publication reported a trend toward higher payments for care in PFP hospitals, 18 and 2 publications did not report statistical analyses but demonstrated higher payments for care in PFP hospitals 19,20 Three studies evaluated payments for care in PFP and NFP hospitals, but the NFP hospitals were a mixture of public and private NFP hospitals [21][22][23] All 3 authors were contacted but were unable to provide the data to compare the PFP and PNFP hospitals. Two publications reported statistically significant higher payments for care in PFP hospitals, 21,22 and 1 publication did not report statistical findings but demonstrated higher payments for care in PFP hospitals 23 One study evaluated charges for care at PFP and PNFP hospitals 24 The author was contacted but was unable to provide payment data.…”

The Profit Doctrine : Economists of the Neoliberal Era

“…In the US, this waste has been estimated at $400 billion (Freeman, 2009; Contrary to Friedman's claims, for-profit health care delivery is more expensive without delivering better care. Medicare spending per capita (adjusted for health characteristics) in communities with for-profit hospitals ($5,172) was higher and increasing faster compared to communities with non-profit hospitals ($4,440) in 1995 (Silverman, et al, 1999; see also Woolhandler & Himmelstein, 1997). A study by Alan Sager and Deborah Socolar of the Boston University School of Public Health estimated that in the US "one-half of health spending goes to clinical and administrative waste, excess prices, and theft" (Sager & Socolar, 2005, p. ii).…”

The Effects of Fraud on the Evaluation of Health Care

“…There are an increasing number of studies on health care practices, financing, and organization that rely on Medicare data, including (to name but a few) research on the use of medical services (Himelhoch et al, 2004), cancer (McClish et al, 2003), hospital quality (Needleman et al, 2003), procedure rates (Escarce and McGuire, 2003), longevity and Medicare spending (Lubitz et al, 1995), hospital ownership and Medicare spending (Silverman and Skinner, 1999), health maintenance organization enrollment patterns (Morgan et al, 1997), the use of mammography (Blustein, 1995), mortality and use of services (Gornick et al, 1996), and the effects of type of hospital on the cost and quality of care (Taylor et al, 1999). These studies are of critical importance for public policy, and for the development of strategies to contain escalating health care costs, but they often rely on corrupted data.…”