INTRODUCTION: Health care spending in the United States continues to draw national attention, accounting for 17.9 percent of total gross domestic product (GDP) or $3.5 trillion dollars in 2017, expected to rise to nearly 20 percent of GDP by 2026. In order to address these expenditures, further examination of rising hospital costs is required. Evidence suggests that for-profit hospitals may be established in areas with well-insured patient populations, while disproportionately offering high-cost, profit-driven interventions over less profitable services. The objective of this study is to compare inpatient mortality, operation rates, length of stay (LOS), and cost of care between private non-profit and for-profit hospitals in the treatment of intracranial hemorrhage. METHODS: This retrospective cohort study used data from the National Inpatient Sample (NIS) database. Primary outcomes including all-cause inpatient mortality, operative status, patient disposition, hospital LOS, total hospital charges, and per-day hospital charges were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographic and comorbidity differences via propensity-score matching. RESULTS: Out of 155 977 unique hospital discharges included in this study, 133 518 originated from private non-profit hospitals and 22 459 from for-profit hospitals. Mortality rates were similar, at 13.80% for non-profit centers and 14.50% at for-profit hospitals. Non-profit hospitals appeared to be more intensive with ICP monitor placement, occurring in 5.50% of patients compared to 4.24% in for-profit centers. Although overall discharge disposition and rate of surgical intervention was similar, LOS was greater among for-profit hospitals at 7.46 d, compared to 6.71 d at non-profit centers. Care at for-profit hospitals was more expensive with total charges amounting to $136,845 versus $85,093 at non-profit institutions. CONCLUSION: Despite similar mortality and discharge disposition, hospital stays for ICH tend to be costlier and longer at for-profit hospitals compared to their non-profit counterparts.

OBJECTIVE:Much of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage. METHODS:This retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology. RESULTS:Of 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00-1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91-1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54-0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12-2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type. CONCLUSIONS:For-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.