For-profit and nonprofit hospitals are statistically hard to tell apart in what they do, how they act and what they charge.

Judge as of 2019-07-18 against the empirical health-economics literature comparing US for-profit and nonprofit hospitals on services offered, behaviour (quality, charity care, efficiency) and prices or charges. True: the weight of studies or reviews available by mid-2019 finds small or statistically insignificant differences between the two types on all three dimensions. Mostly true: differences are small or insignificant on most dimensions, with one modest, consistently found difference, for example in pricing or in the mix of services. Mixed: the literature is split, with clear differences on roughly half the dimensions and none on the rest. Mostly false: the literature finds clear, consistent differences on most dimensions, but some real findings of similarity exist that the claim overstates. False: reviews show large, consistent differences between for-profit and nonprofit hospitals in what they do, how they act and what they charge.

Set before the research began.

1. E1 A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals CMAJ (Canadian Medical Association Journal) · 28 May 2002

   “Meta-analysis of these 14 studies demonstrated that private for-profit hospitals were associated with an increased risk of death (relative risk [RR] 1.020, 95% CI 1.003–1.038; p = 0.02).”

2. E2 Investor Ownership and the Costs of Medical Care National Academies Press (Institute of Medicine, Committee on Implications of For-Profit Enterprise in Health Care), via NCBI Bookshelf · 1986

   “The studies consistently found that prices of for-profit chain hospitals were substantially higher than the prices of not-for-profit hospitals—chain or independent.”

3. E3 Investor Ownership and the Costs of Medical Care National Academies Press (Institute of Medicine, Committee on Implications of For-Profit Enterprise in Health Care), via NCBI Bookshelf · 1986

   “the weight of the evidence and the overall direction is clear: not-for-profit hospitals controlled their expenses more effectively than did for-profit hospitals of the same general size.”

The 1986 Institute of Medicine review found that for-profit chain hospitals consistently charged substantially more than not-for-profit hospitals (E2). It also found that not-for-profit hospitals controlled their expenses more effectively than for-profit hospitals of similar size (E3). A 2002 meta-analysis found a statistically significant but small higher risk of death at for-profit hospitals (RR 1.020) (E1), which is a real difference but close to the near-similarity the claim describes. The evidence shows clear differences in pricing and cost behaviour and a small difference in quality; it says nothing about services offered or charity care, and the IOM sources are dated.