Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care

Restricted access

OBJECTIVE

Much of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage.

METHODS

This retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology.

RESULTS

Of 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00–1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91–1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54–0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12–2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type.

CONCLUSIONS

For-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.

ABBREVIATIONS EVD = external ventricular drain; ICH = intracranial hemorrhage; ICP = intracranial pressure; NIS = National Inpatient Sample.
Article Information

Contributor Notes

Correspondence Ankit I. Mehta: University of Illinois at Chicago, IL. ankitm@uic.edu.INCLUDE WHEN CITING Published online November 29, 2019; DOI: 10.3171/2019.9.JNS191847.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Adams NGibbons KSTudehope D: Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term. Aust N Z J Obstet Gynaecol 57:1761852017

    • Search Google Scholar
    • Export Citation
  • 2

    Ahmed BDavis HTLaskey WK: In-hospital mortality among patients with type 2 diabetes mellitus and acute myocardial infarction: results from The National Inpatient Sample, 2000–2010. J Am Heart Assoc 3:32014

    • Search Google Scholar
    • Export Citation
  • 3

    Altman DFrist WH: Medicare and Medicaid at 50 years: perspectives of beneficiaries, health care professionals and institutions, and policy makers. JAMA 314:3843952015

    • Search Google Scholar
    • Export Citation
  • 4

    Andrulis DPDuchon LM: The changing landscape of hospital capacity in large cities and suburbs: implications for the safety net in metropolitan America. J Urban Health 84:4004142007

    • Search Google Scholar
    • Export Citation
  • 5

    Arora VMoriates CShah N: The challenge of understanding health care costs and charges. AMA J Ethics 17:104610522015

  • 6

    Bailey J: The effect of certificate of need laws on all-cause mortality. Health Serv Res 53:49622018

  • 7

    Brock DWBuchanan AE: The profit motive in medicine. J Med Philos 12:1351987

  • 8

    Caceres JAGoldstein JN: Intracranial hemorrhage. Emerg Med Clin North Am 30:7717942012

  • 9

    Cooper ZCraig SGaynor MHarish NJKrumholz HMVan Reenen J: hospital prices grew substantially faster than physician prices for hospital-based care in 2007–14. Health Aff (Millwood) 38:1841892019

    • Search Google Scholar
    • Export Citation
  • 10

    Cuckler GASisko AMPoisal JAKeehan SPSmith SDMadison AJ: National health expenditure projections, 2017-26: despite uncertainty, fundamentals primarily drive spending growth. Health Aff (Millwood) 37:4824922018

    • Search Google Scholar
    • Export Citation
  • 11

    Etminan NChang HSHackenberg Kde Rooij NKVergouwen MDIRinkel GJE: Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol 76:5885972019

    • Search Google Scholar
    • Export Citation
  • 12

    Ferreira RMde Souza E Silva NASalis LHA: Complications after elective percutaneous coronary interventions: a comparison between public and private hospitals. Indian Heart J 70:32362018

    • Search Google Scholar
    • Export Citation
  • 13

    Fox DM: Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA. Milbank Q 93:1792102015

    • Search Google Scholar
    • Export Citation
  • 14

    Griffin MRZhu YMoore MRWhitney CGGrijalva CG: U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med 369:1551632013

    • Search Google Scholar
    • Export Citation
  • 15

    Horwitz JR: Making profits and providing care: comparing nonprofit, for-profit, and government hospitals. Health Aff (Millwood) 24:7908012005

    • Search Google Scholar
    • Export Citation
  • 16

    Hoxha ISyrogiannouli LLuta XTal KGoodman DCda Costa BR: Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open 7:e0136702017

    • Search Google Scholar
    • Export Citation
  • 17

    Hung PCasey MMKozhimannil KBKaraca-Mandic PMoscovice IS: Rural-urban differences in access to hospital obstetric and neonatal care: how far is the closest one? J Perinatol 38:6456522018

    • Search Google Scholar
    • Export Citation
  • 18

    Ikram MAWieberdink RGKoudstaal PJ: International epidemiology of intracerebral hemorrhage. Curr Atheroscler Rep 14:3003062012

  • 19

    Kaiser Family Foundation: Hospitals by ownership type. (https://www.kff.org/other/state-indicator/hospitals-by-ownership/) [Accessed October 4 2019]

    • Export Citation
  • 20

    Khan NAQuan HBugar JMLemaire JBBrant RGhali WA: Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 21:1771802006

    • Search Google Scholar
    • Export Citation
  • 21

    Khera RAngraal SCouch TWelsh JWNallamothu BKGirotra S: Adherence to methodological standards in research using the National Inpatient Sample. JAMA 318:201120182017

    • Search Google Scholar
    • Export Citation
  • 22

    Lee DKChertow GMZenios SA: Reexploring differences among for-profit and nonprofit dialysis providers. Health Serv Res 45:6336462010

    • Search Google Scholar
    • Export Citation
  • 23

    Lin DGoldberg JDHochman TLevinson BAKhan MNewman E: Delivery of adjuvant chemotherapy among stage III colon cancer patients at a public versus private hospital in New York City. Cancer Causes Control 29:2532602018

    • Search Google Scholar
    • Export Citation
  • 24

    McAleese POdling-Smee W: The effect of complications on length of stay. Ann Surg 220:7407441994

  • 25

    New York Public Health Law, art. 282015

  • 26

    Newgard CDMann NCHsia RYBulger EMMa OJStaudenmayer K: Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems. Acad Emerg Med 20:9119192013

    • Search Google Scholar
    • Export Citation
  • 27

    Sahni RWeinberger J: Management of intracerebral hemorrhage. Vasc Health Risk Manag 3:7017092007

  • 28

    Seder CW: Adding value in healthcare: understanding the whole denominator. J Thorac Dis 9:483548362017

  • 29

    Seiber EE: Physician code creep: evidence in Medicaid and State Employee Health Insurance billing. Health Care Financ Rev 28:83932007

    • Search Google Scholar
    • Export Citation
  • 30

    Sloan FATrogdon JGCurtis LHSchulman KA: Does the ownership of the admitting hospital make a difference? Outcomes and process of care of Medicare beneficiaries admitted with acute myocardial infarction. Med Care 41:119312052003

    • Search Google Scholar
    • Export Citation
  • 31

    Tavakoli SPeitz GAres WHafeez SGrandhi R: Complications of invasive intracranial pressure monitoring devices in neurocritical care. Neurosurg Focus 43(5):E62017

    • Search Google Scholar
    • Export Citation
  • 32

    Turrentine FEBuckley PJSohn MWWilliams MD: Travel time influences readmission risk: geospatial mapping of surgical readmissions. Am Surg 83:5735822017

    • Search Google Scholar
    • Export Citation
  • 33

    Woolhandler SHimmelstein DU: The high costs of for-profit care. CMAJ 170:181418152004

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 237 237 237
Full Text Views 30 30 30
PDF Downloads 13 13 13
EPUB Downloads 0 0 0
PubMed
Google Scholar