Patient-centric care in the U.S. - A comparative study of patient satisfaction and quality care among for-profit physician-owned, corporate-owned, and not-for-profit hospitals

Abstract

This dissertation examines the effects of physician ownership of hospitals on the quality of patient-centric care in the U.S. The health care sector in the U.S. is becoming more aligned with markets and in turn, with consumers’ preferences. In consumer driven service industries, consumer satisfaction is considered a key criterion to judge quality. In the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys, physician-owned hospitals (POHs) get more top 5-Star ratings than other hospitals. However, it is not known whether higher perceived patient satisfaction is because of better inpatient experience or due to better health related outcomes. Ratings also do not clarify variations between specialty and general service POHs. The study compares the quality of care in POHs with that in other major forms of hospitals (corporate-owned, and not-for-profit). The Affordable Care Act (ACA) regulated physician ownership of hospitals due to concerns that physicians’ profit motive might negatively affect the quality of care. This non-experimental study used bivariate and multivariate analyses to examine variation in the quality of care among types of hospitals in 2017 and 2018 using patient satisfaction and clinical outcomes as indicators of quality. This study used two samples, a full and a restricted sample. Full sample compared all POHs (specialty and general service) with other hospitals. Restricted sample included only general service hospitals. Patients in POHs were found to have higher perceived satisfaction, and viewed providers’ practices more favorably in the full sample. In the restricted sample, however, not-for-profit (NFP) hospitals provided relatively better care. Corporate-owned hospitals had lowest patient satisfaction and poorest outcomes. Results indicate POHs are competitive with not-for-profit hospitals on patient satisfaction dimension of quality care. Multivariate analyses suggest that the effects of physician ownership go away when mediation by providers’ practices is considered. NFP hospitals, however, continue to provide better overall value of care. The results do not support reconsideration of the ACA restrictions on POHs. Patient satisfaction may be contingent upon patient-centric practices than type of hospital, but hospital ownership may affect preference for some practices over others. Outcomes may not matter when patients’ perceptions measure quality.