Does Hospital For-Profit Status Affect Intracranial Hemorrhage Outcomes and Cost of Care?

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.