Performance evaluations of for‐profit and nonprofit U.S. hospitals since 1980

This synthesis of studies examines whether the published literature shows an evidence‐based consensus on performance differences between private for‐profit and nonprofit hospitals in the United States since 1980. The author systematically and comprehensively surveyed peer‐reviewed publications to clarify this question. The author's second objective was to learn what proportion of all research assessing for‐profit and nonprofit health care providers is devoted to hospitals compared to all other providers. The third goal was to discover how any trends in observed performance differences among hospitals compare with trends among other provider types. Computerized bibliographic searches of all relevant databases yielded seventy‐five studies (ninety‐three assessments) that compared the performance of for‐profit and nonprofit hospitals on four performance criteria: access, quality, cost or efficiency, and amount of charity care. The author coded findings on performance in one of three ways: for‐profit superiority, nonprofit superiority, or inconclusive. Most studies (60 percent) reported that nonprofit hospitals have better relative performance than for‐profit hospitals, clear evidence of their organizational effectiveness. Thirty‐one percent were inconclusive, and 8 percent reported that for‐profits were better.