Patients at for-profit hospitals had higher 30-day mortality and readmission rates than patients at nonprofit hospitals, according to a study led by researchers at the University of Pennsylvania School of Nursing in Philadelphia.
Nurses at for-profit hospitals were also more likely to rate their staffing as unsafe, which the researchers linked to part of the difference in outcomes.
Researchers from Penn Nursing’s Center for Health Outcomes and Policy Research and the University of Pennsylvania’s Leonard Davis Institute of Health Economics published the study in Medical Care. They used 2024 data on more than 1.17 million Medicare admissions at 143 for-profit and 798 nonprofit acute care hospitals in 10 states. The study also drew on survey responses from 17,368 bedside registered nurses.
Five takeaways:
1. At for-profit hospitals, 71% of nurses said their patient workloads were unsafe, compared with 54% at nonprofit hospitals.
2. Compared with nonprofit hospitals, for-profit hospitals had:
- About 11 more deaths per 1,000 medical admissions and five more per 1,000 surgical admissions. In the researchers’ analysis, staffing differences were linked to about 40% and 45% of those gaps, respectively.
- 30-day readmission rates 2.04 percentage points higher for medical patients and 1.76 percentage points higher for surgical patients.
- Overall HCAHPS hospital ratings 4.45 percentage points lower.
- Nurse burnout rates 9 percentage points higher, with staffing linked to about two-thirds of that difference.
3. Fifty-one percent of nurses at for-profit hospitals said they would not recommend their hospital to family, compared with 26% at nonprofit hospitals.
4. Researchers noted that more than a third of hospitals are for-profit in some states, yet few rules address ownership-related quality concerns. They called for minimum staffing standards, more transparency about who owns hospitals, and workforce measures in payment and accountability programs.
“Treating safe nurse staffing as a core component of quality rather than a discretionary operating expense is especially important where incentives to cut labor costs are strongest,” lead author Matthew McHugh, PhD, RN, director of the Center for Health Outcomes and Policy Research, said in an Oct. 7 news release.
5. Dr. McHugh and his co-authors acknowledged several limitations. Because the study captures a single point in time, it shows associations rather than cause and effect. It relied on nurses’ own staffing assessments and could not account for every difference between hospitals, including physician composition, leadership quality and local market conditions. Studies using other methods have found smaller effects of ownership on mortality, or none at all.
