The growing influence of corporate ownership in healthcare is raising fresh concerns about whether financial priorities are coming at the expense of patient safety. New research suggests that patients admitted to for-profit hospitals face greater risks of death and hospital readmission. At the same time, nurses struggle with heavier workloads, inadequate staffing and more challenging working conditions.

The study, led by researchers at the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research (CHOPR) and the Leonard Davis Institute of Health Economics, highlights troubling differences between for-profit and nonprofit hospitals. Published in the journal Medical Care, the findings suggest that nursing shortages may help explain why patients at for-profit facilities experience poorer outcomes.

Researchers examined data involving more than 1.17 million patients treated at 143 for-profit and 798 nonprofit acute care hospitals across 10 US states. The results revealed significant differences in patient survival, hospital readmissions, nursing workloads and overall care quality.

Among the most concerning findings, patients at for-profit hospitals experienced approximately 11 additional deaths per 1,000 medical admissions and five additional deaths per 1,000 surgical admissions compared with those at nonprofit hospitals. Differences in nurse staffing emerged as a major factor associated with these higher mortality rates.

Hospital readmissions also painted a troubling picture. Within 30 days of discharge, for-profit hospitals recorded approximately 20 additional readmissions per 1,000 medical patients and 18 additional readmissions per 1,000 surgical patients. Researchers estimated that staffing differences explained 16% and 30% of these gaps, respectively.

For nurses, the working environment was equally concerning. An overwhelming 71% of nurses employed at for-profit hospitals reported that their assigned patient workloads were unsafe. Burnout was also significantly higher, and nurses were considerably less likely to recommend their hospitals to family and friends, either as places to receive treatment or to work.

Patients themselves appeared to recognise these shortcomings. For-profit hospitals received lower overall patient ratings, with inadequate nurse staffing helping to explain the poorer assessments. The findings suggest that staffing decisions affect not only nurses’ working conditions but also patients’ experiences and quality of care.

“Treating safe nurse staffing as a core component of quality rather than a discretionary operating expense is especially important where incentives to cut labor costs are strongest,” said lead author Matthew D. McHugh, professor of nursing and director of CHOPR at Penn Nursing. He emphasised that minimum staffing requirements and greater transparency around hospital ownership could provide important protections.

As healthcare systems face growing financial pressures, the researchers argue that investing in nursing should be viewed as essential to patient safety rather than an optional expense. They recommend stronger policies establishing minimum safe staffing levels and greater ownership transparency to improve patient outcomes, reduce nurse burnout and ensure quality care regardless of whether hospitals operate for profit.

More information: Matthew D. McHugh et al, Patient Outcomes and Nurse Understaffing in For-Profit Hospitals, Medical Care. DOI: 10.1097/MLR.0000000000002376

Journal information: Medical Care Provided by University of Pennsylvania School of Nursing