March, 2000
Journal of General Internal Medicine Editorial Cites Cuts in Nursing, Focus on Profits
According to a study and editorial released today, patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer adverse events such as complications following surgery or delays in diagnosing and treating an ailment.
“This study is another warning for those who would trust hospital care to the marketplace,” said Dr. Gordon Schiff, author of the editorial (“Fatal Distraction” JGIM, April, 2000).
Previous research has found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and 6 to 7 percent higher than at non-profit, non-teaching hospitals. In addition, for-profit hospitals employ fewer nurses, charge higher prices (costing Medicare an additional $5.2 billion annually) and spend a higher percentage of their budgets on overhead.
A study published last year in the Journal of the American Medical Association also found that for-profit HMOs are lower quality than not-for-profit HMOs on 14 quality measures.
Dr. Schiff cited a remarkable study on blood donation by Dr. Richard Titmuss (“The Gift Relationship”), published three decades ago which found that for-profit blood centers were less efficient, more costly, and more dangerous to patients than voluntary, non-profit centers.
“Hospital managers and even medical staffs are preoccupied with survival in the marketplace,” said Dr. Schiff. “This preoccupation represents a “fatal distraction” from the real business of health care — caring for patients and improving quality.”
“We’re very concerned that non-profit hospitals will be forced to adopt the same cost- and quality-cutting measures of the for-profits,” continued Dr. Schiff. “It’s much easier to measure money than quality of care.”
Public non-teaching hospitals also had higher rates of adverse events than not-for-profit hospitals and teaching institutions, which the study suggests may be due to insufficient funding during the study period. The study examined 15,000 patients hospitalized in Utah and Colorado in 1992, and many small public Colorado hospitals experienced financial losses that year.
“The competitive free market described in textbooks doesn’t and can’t exist in health care,” says Dr. Claudia Fegan, an internist in Chicago and former medical director of Michael Reese hospital in Chicago. “Seriously ill patients can’t comparison shop or accurately judge quality. We need a not-for-profit national health system to increase access for the millions of uninsured, to strengthen our nation’s health care safety net, and to improve quality for all.”