>Date: Wed, 4 Aug 1999 12:40:23 EDT
>From: [log in to unmask]
>Subject: NEJM study shows inferior quality of care at for-profit hospitals
>
>New England Journal of Medicine Editorial
>Says Evidence Against For-Profit Hospitals Now Conclusive
>
>For-Profit Hospitals Deliver Inferior Care at Inflated Prices and
>Cost Medicare an Extra $5.2 Billion Annually
>
>§ An editorial and study in today's New England Journal of Medicine (NEJM)
>concludes that for-profit hospitals are more expensive than not-for-profit
>facilities. For-profit hospitals cost Medicare an additional $732 per
>enrollee, or an extra $5.2 billion, in 1995 alone ("The Association Between
>For-Profit Hospital Ownership and Increased Medicare Spending," NEJM, August
>5, 1999). The editorial also notes that substantial prior research confirms
>that for-profit hospitals are 3 to11 percent more expensive and spend more
on
>overhead and administration while hiring fewer nurses, providing less
charity
>care, and providing patients with fewer hospital days than not-for-profit
>facilities.
>
>§ The editorial also concludes that for-profit hospitals are lower in
quality
>than not for-profit facilities, based on a review of nearly two decades of
>peer-reviewed literature ("When Money is the Mission - The High Costs of
>Investor-Owned Care," NEJM, August 5, 1999). For example, two recent studies
>have found death rates 6 to 7 percent lower at private non-profit hospitals
>and 25 percent lower at teaching hospitals than at for-profit facilities.
>Other studies have found more post-operative complications and preventable
>adverse events at for-profit facilities.
>
>§ The editorial is authored by Harvard Medical School Associate Professors
>Steffie Woolhandler, MD and David U. Himmelstein, MD, co-authors of a July
14
>study in the Journal of the American Medical Association showing that
>investor-owned HMOs are lower-quality than not-for-profits on every single
>one of 14 quality measures (Quality of Care in Investor-owned vs.
>Not-for-Profit HMOs). Dr. Himmelstein and Woolhandler are also co-founders
of
>Physicians for a National Health Program.
>
>§ The study on hospitals, performed by Dartmouth Medical School researchers
>Elaine Silverman, MD, MPH, Elliott Fisher, MD, MPH, and Jonathan Skinner,
PhD
>finds substantially higher Medicare costs and more rapid price increases in
>communities dominated by for-profit hospitals. The authors may be reached at
>(802) 295-9363 x5545 (ES), (603) 650-1822 (EF), and (603) 646-2535 (JS).
>
>-- According to an editorial in today's New England Journal of Medicine,
>for-profit hospitals provide lower quality care while charging higher prices
>than not-for profit facilities. The editorial, which accompanies a study on
>the impact of investor-ownership on Medicare costs, comes just three weeks
>after the publication of research showing that investor-owned HMOs scored
>lower on every single one of 14 quality measures and spent 48 percent more
on
>overhead and profits than not-for-profit HMOs.
>
>Like their cousins in the HMO industry, "investor-owned hospitals are profit
>maximizers, not cost minimizers. Strategies that bolster profitability, like
>Columbia HCA's glitzy advertising, can worsen efficiency. The competitive
>free market described in textbooks doesn't and can't exist in health care,"
>says Drs. Steffie Woolhander. "Seriously ill patients can't comparison shop
>or accurately judge quality, especially when for-profit HMOs and hospitals
>try to mislead consumers."
>
>Co-author Dr. David Himmelstein notes that "for-profit medicine turns
doctors
>and nurses into tools of Wall Street and patients into commodities....Our
>society recognizes that some things are too intimate or corruptible to trust
>to the market. We prohibit selling children and buying juries. Investors
>should not profit from suffering. For-profit hospitals and HMOs should be
>banned."
>
>    "The editorial and study conclusively demonstrate - if there was any
>doubt left -- that marketplace medicine is a failed experiment," says Dr.
>Quentin Young, National Coordinator, Physicians for a National Health
Program
>and an internist in Chicago. "We have 45 million people without any
insurance
>and 125,000 additional people losing their insurance every month. Every day
>there's more bad news about how rotten our health system is - prices rising,
>quality falling, and, just this month, an additional 250,000 seniors being
>dumped from Medicare HMOs."
>
>"The so-called "Patient Bill of Rights" defeated last month was so
threadbare
>it didn't even include the right to health care" continues Dr. Young.  "The
>good news is, there's an obvious solution to this chaos, and one we must
>study hard: a single payer not-for-profit national health program like they
>have in Canada (our much poorer neighbor to the north) or Scandinavia (where
>doctors still make house calls). The American people rate "insuring
everyone"
>their top health care priority for government (CBS poll, July, 1999). In the
>2000 Presidential elections, let's ensure that at least one candidate will
>have the courage to insist that health care be a human right and refuse to
>accept any campaign funding from for-profit HMOs, hospitals, physicians'
>groups, nursing homes and drug companies."
>###
>
>Physicians for a National Health Program (PNHP) is an organization of over
>8,000 physicians that support national health insurance. PNHP was founded in
>1987 and has chapters across the U.S. To contact a spokesperson in your
area,
>call the PNHP headquarters in Chicago at (312) 554-0382 or see www.pnhp.org.
>
>        "Of all the forms of inequality, injustice in health care
>is the most shocking and inhumane." -- Rev. Martin Luther King, Jr.
>
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
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