Does the ownership of the admitting hospital make a difference? Outcomes and process of care of Medicare beneficiaries admitted with acute myocardial infarction

Med Care. 2003 Oct;41(10):1193-205. doi: 10.1097/01.MLR.0000088569.50763.15.


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, beta-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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Cardiovascular Surgical Procedures / statistics & numerical data
  • Diagnostic Techniques, Cardiovascular / statistics & numerical data
  • Female
  • Hospital Mortality
  • Hospitals, Private / statistics & numerical data*
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Outcome and Process Assessment, Health Care
  • Ownership / statistics & numerical data*
  • Patient Admission / statistics & numerical data*
  • Socioeconomic Factors
  • United States / epidemiology