Camilo Cid Pedraza, Cristian A. Herrera, Lorena Prieto Toledo, and Felipe Oyarzún Public, private not-for-profit (PNFP) and private for-profit (PFP)
hospitals may have different behaviour and performance
in different indicators such as health outcomes,
cost-efficiency and quality. Chile has a mixed healthcare system both in
financing and service delivery. The public National
Health Fund (Fondo Nacional de Salud) covers 76% of the
population—poorer
and with higher health risks—whereas private health
insurers cover 16% of the population—richer and with lower health
risks.
The aim of the study was to analyse the in-patient
mortality outcomes by hospital ownership in Chile. Methods: We use
hospital
discharge data in Chile for the period 2001–10 with
a total of 16 205 314 discharges in 20 public, 6 PNFP and 15 PFP
hospitals.
We analyse in-patient mortality considering all
diagnoses and a subsample considering only myocardial infarction and
stroke
diagnoses. Using a probit regression, we estimate
how hospital ownership explains in-patient mortality controlling for
other
confounding variables like health and socioeconomic
status, and hospital characteristics. Results: The discharge condition
was reported as death in 3.5% of the public
hospitals’ discharges, 1.3% in PNFP and 0.7% in PFP. PNFP and PFP
hospitals show
a lower risk of in-hospital mortality for all
diagnoses, myocardial infarction and stroke in comparison with public
hospitals.
Discussion: The question about which type of
hospital ownership performs better in Chile remains open. Policy
decisions regarding
health service provision requires more evidence
explaining differences by ownership. Better controls for health risk and
hospital
characteristics are suggested to address these
differences in hospital performance. |