Working Paper: NBER ID: w12241
Authors: Karen Eggleston; Yuchu Shen; Joseph Lau; Christopher H. Schmid; Jia Chan
Abstract: Does quality of care systematically differ among government-owned, private not-for-profit, and for-profit hospitals? A large empirical literature provides conflicting evidence. Through quantitative review of 46 studies since 1990, we find that several study features that can explain divergent results: analytic methods, disease studied, and data sources. For unprofitable care, how studies handle market competition and regional differences account for substantial variation. Policymakers should be aware that differences in results appear to arise predominantly from differences between studies' analytic methods. Moreover, conventional methods of meta-analytic synthesis should be applied with great caution given the considerable overlap among studied hospitals.
Keywords: hospital ownership; quality of care; meta-regression; healthcare financing
JEL Codes: I1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| hospital ownership type (L32) | quality of care (I11) |
| government-owned hospitals (L32) | short-term mortality rates (I12) |
| private not-for-profit hospitals (L39) | short-term mortality rates (I12) |
| for-profit hospitals (L39) | short-term mortality rates (I12) |
| analytic methods (C38) | variation in study outcomes (C90) |
| patient-level data (I10) | outcomes (P47) |
| hospital-level data (I10) | outcomes (P47) |
| adjusting for patient comorbidities (I11) | quality gap (L15) |
| panel data estimation methods (C23) | differences in quality (L15) |
| cross-sectional data (C80) | differences in quality (L15) |