The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China
Abstract Background Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developin...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Archives of Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13690-023-01029-y |
| _version_ | 1811166093779140608 |
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| author | Qingping Xue Dong Roman Xu Terence C. Cheng Jay Pan Winnie Yip |
| author_facet | Qingping Xue Dong Roman Xu Terence C. Cheng Jay Pan Winnie Yip |
| author_sort | Qingping Xue |
| collection | DOAJ |
| description | Abstract Background Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. Methods A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. Results The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. Conclusion The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals’ performances among different ownership types under China’s context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges. |
| first_indexed | 2024-04-10T15:46:56Z |
| format | Article |
| id | doaj.art-f109a5003a214131aa6833da1db83590 |
| institution | Directory Open Access Journal |
| issn | 2049-3258 |
| language | English |
| last_indexed | 2024-04-10T15:46:56Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Archives of Public Health |
| spelling | doaj.art-f109a5003a214131aa6833da1db835902023-02-12T12:05:16ZengBMCArchives of Public Health2049-32582023-02-0181111610.1186/s13690-023-01029-yThe relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in ChinaQingping Xue0Dong Roman Xu1Terence C. Cheng2Jay Pan3Winnie Yip4School of Public Health, Chengdu Medical CollegeCenter for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical UniversityHarvard TH Chan School of Public HealthHEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan UniversityHarvard TH Chan School of Public HealthAbstract Background Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. Methods A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. Results The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. Conclusion The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals’ performances among different ownership types under China’s context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.https://doi.org/10.1186/s13690-023-01029-yPrivate hospitalFor-profit hospitalQuality of careMedical expenseChina |
| spellingShingle | Qingping Xue Dong Roman Xu Terence C. Cheng Jay Pan Winnie Yip The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China Archives of Public Health Private hospital For-profit hospital Quality of care Medical expense China |
| title | The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China |
| title_full | The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China |
| title_fullStr | The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China |
| title_full_unstemmed | The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China |
| title_short | The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China |
| title_sort | relationship between hospital ownership in hospital mortality and medical expenses an analysis of three common conditions in china |
| topic | Private hospital For-profit hospital Quality of care Medical expense China |
| url | https://doi.org/10.1186/s13690-023-01029-y |
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