The study, by researchers from McMaster University in Hamilton, Ontario, and the University of Toronto, both in Canada and the University at Buffalo was published Monday in the Canadian Medical Association Journal.

"The reason why private for-profit hospitals have higher mortality is because they have less highly skilled professionals -- less board-certified physicians, less registered nurses, less pharmacists," Dr. P. J. Devereaux, research fellow in the departments of Medicine and Clinical Epidemiology, and Biostatistics at McMaster University, told United Press International.

"Hospitals have become more efficient, but the for-profit hospitals have to pay taxes and satisfy shareholders using the same Medicare reimbursement rate."

Canadians are engaged in an intense debate about the relative merits of private for-profit versus private not-for-profit healthcare delivery, so researchers undertook a meta-analysis, or a systemic review of relevant studies to answer that question, Devereaux said.

"The emphasis has been on determining if for-profit hospitals can contain costs and run more efficiently -- if having for-profits would create 'two-tier medicine' -- and on the potential for foreign investors to become involved and influence Canadian health policy in light of NAFTA (North American Free Trade Agreement)," Devereaux said. "What has been missing from this debate is how expansion of private for-profit hospitals would affect patients."

Private not-for-profit hospitals are owned by religious organizations, communities, regional health authorities or hospital boards of directors. Public not-for-profit hospitals are owned by governments and for-profit hospitals are owned by shareholders or investors. In the United States, about 12 percent of hospitals are for-profit, according to the researchers.

"Although the relative increase in risk amounts to 2 percent in our analysis or 2,047 deaths, this may seem small, but it is statistically significant and could have a fairly large impact," Dr. Holger Schunemann, of the University at Buffalo department of social and preventive medicine, told UPI. "In Canada, that is equivalent to 2,200 deaths yearly, which equals the Canadian death rates for suicide, colon cancer or motor vehicle accidents."

If all hospitals in the United States became for-profit hospitals, 14,300 additional deaths would result, according to Schunemann.

"These issues raise concerns that the profit motive causes hospitals to limit care in ways that affect patient outcomes, and our findings suggest such concerns are justified," Devereaux said.

Devereaux pointed out that for-profit hospitals had fewer highly skilled personnel per "risk-adjusted" bed, a statistic strongly associated with hospital mortality rates.

Differences in mortality rates between for-profit and not-for-profit decreased when researchers adjusted statistically for staffing levels, he said.

"It's important data, and expenditures must always be considered, but high-quality hospital staff recruitment also has to do with hospital philosophy and mission and not just money," Dr. Herbert Pardes, president and chief executive officer of the New York-Presbyterian Healthcare System, which comprises more than 30 hospitals in the tri-state New York metro region, told UPI. "Institutions that value quality, the best doctors, the best staff and the best programs will have quality outcomes."

"However, if I needed a procedure I'd choose a hospital that did a high volume of them, because those that are really experienced have better outcomes," he added.

The researchers examined 8,500 abstracts of reports in pairs, and 800 were considered relevant by both researchers and were chosen for full review. Data and the results of each article were blacked out by magic marker so that the results would not influence the selection of the studies considered eligible for the analysis, according to Devereaux.

Fifteen studies involving 38 million patients were analyzed and took into account teaching status of the hospital, the patients' severity-of-illness and hospitals' case mix.

"Medicare patients, or publicly funded patients were chosen for the analysis," Devereaux said. "It's the exact structure relevant to Canada, but we did not look at diseases or length of stay."

The meta-analysis results have significant implications for healthcare delivery in both Canada and the United States, according to the researchers.

"All data are derived from U.S. studies," said Schunemann. "The results are directly applicable to the American public. Being treated in a private for-profit hospital puts patients at increased risk, and the number of private for-profit hospitals in the United States is growing."

Devereaux said the Canadian health system is at a crucial juncture. "Many individuals are suggesting we would be better served with private for-profit healthcare delivery but our systematic review raises concerns about the potential negative health outcomes associated with for-profit hospitals," he said.

"Canadian policy makers, the stakeholders who influence them and the public, whose health will be affected by their decisions, should take this evidence into account."

Reported by Alex Cukan in Albany, N.Y.

Copyright 2002 by United Press International. All rights reserved.

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