The ownership of health facilities and clinical decisionmaking. The case of the ESRD industry

Med Care. 1989 Mar;27(3):244-58. doi: 10.1097/00005650-198903000-00003.


The growth of investor-owned health care facilities raises questions about the relationship between profit seeking and medical decisionmaking. The authors compared the treatment received by patients with end-stage renal disease in private nonprofit, for-profit, and public facilities. Using data collected by the Health Care Financing Administration in 1981, they found that facility ownership had a significant independent effect on treatment of renal failure. In particular, patients at for-profit facilities were more likely to be dialyzed in the center and less likely to receive kidney transplants, home dialysis, or peritoneal dialysis than were their counterparts in nonprofit and public facilities. These findings persisted after controlling for characteristics of patients, the facility, and the local health care system, suggesting the need for further research and policy initiatives to deal with this issue.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • Delivery of Health Care
  • Health Facilities* / economics
  • Health Facilities, Proprietary* / economics
  • Hemodialysis, Home
  • Home Care Services
  • Humans
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation
  • Ownership*
  • Patient Selection
  • Peritoneal Dialysis, Continuous Ambulatory
  • Physicians*
  • Renal Dialysis*