| VOLUME 33, NUMBER 29 | THURSDAY, June 27, 2002 |
Hospital
mortality rates analyzed
By
LOIS BAKER A
study of data from more than 26,000 U.S. hospitals covering outcomes
of 38 million patients has shown that people treated in private for-profit
hospitals in the U.S. have a greater risk of dying than those cared
for in private not-for-profit hospitals.
The
study, carried out by researchers from UB, McMaster University in Hamilton,
Ontario, and the University of Toronto, appeared last month in the Canadian
Medical Association Journal (CMAJ).
The
researchers undertook the meta-analysis of mortality statistics to help
inform the debate under way in Canada over whether to move into the
for-profit health-care-delivery arena.
"Most
of the debate so far has focused on economics," said P. J. Devereaux,
research fellow in the departments of Medicine and Clinical Epidemiology
and Biostatistics at McMaster University and lead author on the study.
"The emphasis has been on determining if for-profit hospitals can contain
costs and run more efficiently; if having for-profits would create 'two-tier
medicine,' and on the potential for foreign investors to become involved
and influence Canadian health policy in light of NAFTA (North American
Free Trade Agreement).
"What
has been missing from this debate is how expansion of private for-profit
hospitals would affect patients," he said. "We undertook the study to
find out the relative impact of private for-profit versus private not-for-profit
delivery of hospital care on patient mortality."
Private
not-for-profit hospitals are owned by religious organizations, communities,
regional health authorities or hospital boards. For-profit hospitals
are owned by shareholders or investors.
To
conduct their review, the researchers systematically identified all
relevant studies that compared private for-profit with private not-for-profit
hospital mortality. They ended up analyzing 15 studies containing data
from approximately 38 million patients hospitalized in 26,000 U.S. hospitals
between 1982 and 1995. The data were adjusted for confounders such as
teaching status of the hospital, the patients' severity of illness and
hospitals' case mix.
Results
showed that for-profit hospitals were associated with significantly
higher mortality.
"Although
the relative increase in risk amounts to 2 percent in our analysis,
which may seem small, the absolute number is frightening," said Holger
Schunemann, assistant professor of medicine and social and preventive
medicine, and UB author on the study.
"In
Canada, this percent is equivalent to 2,200 deaths yearly, which equals
Canadian death rates for suicide, colon cancer or motor -ehicle accidents.
The total numbers will be much higher in the U.S.," he said. "They speak
for themselves."
The
researchers point to pressure to achieve the expected profit for investors
as the probable cause of this increase in mortality.
"Heads
of for-profit hospitals are rewarded based on meeting or surpassing
the profit margin," said Devereaux. When reimbursement comes from the
same source as not-for-profits, such as from Medicare, for-profits are
faced with trying to achieve the same outcomes while having less to
spend on patient care.
"These
issues raise concerns that the profit motive causes hospitals to limit
care in ways that affect patient outcomes, and our findings suggest
such concerns are justified."
The
meta-analysis results have significant implications for health-care
delivery.
"All
data are derived from U.S. studies," said Schunemann. "The results are
directly applicable to the American public. Being treated in a private
for-profit hospital puts patients at increased risk, and the number
of private for-profit hospitals in the U.S. is growing."
Additional
researchers from McMaster University were Peter T-L Choi, Christina
Lacchetti, Bruce Weaver, Ted Haines, John Lavis, David R.S. Halsam,
Mohit Bhandari, Deborah J. Cook, Stephen D. Walter, Maureen Meade, Humaira
Khan, Neera Bhatnagar and Gordon H. Guyatt.
Brydon
J.B. Grant from the UB Department of Medicine and Terrence Sullivan
from the Department of Health Policy Management and Evaluation at the
University of Toronto also participated.
Contributing Editor