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Hospital ownership and quality of care: what explains the different results in the literature?

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  • Karen Eggleston

    (Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, CA, USA)

  • Yu-Chu Shen

    (National Bureau of Economic Research and Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, CA, USA)

  • Joseph Lau

    (The Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA)

  • Christopher H. Schmid

    (The Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA)

  • Jia Chan

    (FSI, CHP|PCOR Research Staff, Stanford University, Stanford, CA, USA)

Abstract

This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The 'true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time. Copyright © 2008 John Wiley & Sons, Ltd.

Suggested Citation

  • Karen Eggleston & Yu-Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:12:p:1345-1362 DOI: 10.1002/hec.1333
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    1. Zhou, Wenhui & Wan, Qiang & Zhang, Ren-Qian, 2017. "Choosing among hospitals in the subsidized health insurance system of China: A sequential game approach," European Journal of Operational Research, Elsevier, vol. 257(2), pages 568-585.
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    7. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
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