NDLI: The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China

Content Provider	Springer Nature : BioMed Central
Author	Xue, Qingping Xu, Dong Roman Cheng, Terence C. Pan, Jay Yip, Winnie
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.
Related Links	https://archpublichealth.biomedcentral.com/counter/pdf/10.1186/s13690-023-01029-y.pdf
Ending Page	16
Page Count	16
Starting Page	1
File Format	HTM / HTML
ISSN	20493258
DOI	10.1186/s13690-023-01029-y
Journal	Archives of Public Health
Issue Number	1
Volume Number	81
Language	English
Publisher	BioMed Central
Publisher Date	2023-02-10
Access Restriction	Open
Subject Keyword	Public Health Medicine Health Policy Health Services Research Health Informatics Private hospital For-profit hospital Quality of care Medical expense China Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.2/2023
5-Year Journal Impact Factor	3.3/2023

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