Does the Ownership of the Admitting Hospital Make a Difference?: Outcomes and Process of Care of Medicare Beneficiaries Admitted With Acute Myocardial Infarction

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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, β-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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