Varying ranges of hospital services widen gaps in care, study finds

For-profit hospitals are more likely to discontinue less profitable services than public and nonprofit hospitals, new research shows.

According to an analysis of data on 2,500 city hospitals from 2004 to 2019 published in Health Affairs on Monday.

This variation resulted in a shortage of less profitable services such as psychiatric care and addiction treatment and a surplus of high-margin services such as invasive heart surgeries, the researchers found.

“We wanted to look at the contribution of hospital ownership to the delivery of care. The answer should be nothing, once you take size and location out of the equation,” said Julie Horwitz, lead author of the study and a professor at the University of California, The bone Angeles School of Law. “Ownership matters in a surprising way. It’s not what I expected.”

Here are five takeaways from the study:

  1. Just over half of the hospitals offered emergency psychiatric services, which tend to be quite unprofitable. But that burden fell disproportionately on nonprofit and government hospitals. These hospitals were much more likely to provide emergency psychiatric services than for-profit facilities. For-profit hospitals were also much less likely to provide HIV/AIDS care, addiction treatment, palliative care and obstetric care.
  2. An equal share—49% of nonprofits and for-profits—provided heart surgery for adults. But overall, nonprofits did not offer as many for-profit adult cardiac services as their for-profit counterparts. That may be because nonprofit facilities lack the resources to acquire the latest equipment or hire the best clinicians, Horowitz said. “We have to be careful about telling nonprofit hospitals to do things that cost them money, because that money has to come somewhere,” Horwitz said.
  3. Not enough attention is paid to service line offerings to assess whether nonprofit hospitals are getting their tax exemptions, the researchers wrote. Because federal policy governing nonprofit hospitals focuses primarily on their responsibility to improve access for low-income people, it fails to take into account that these facilities offer a wider range of services than their competitors. taxed. “The way we measure community benefits is how much money they spend on providing free care or doing things that hospitals are ill-equipped to do, like developing housing policy,” he said. said Horwitz.
  4. The researchers did not find significant differences in the range of service offerings related to system-owned hospitals compared to independent hospitals.
  5. According to the study, nonprofit and government hospitals were more likely to replicate for-profit service combinations when for-profit hospitals entered their markets. The reverse was not the case. “That felt extremely important to me,” Horwitz said.

About Bradley J. Bridges

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