Care quality declines when hospital privatizes for profit
National Nurses United points out that privatization of hospitals and elimination of both hospitals and nurses results in neglectful care for patients. | National Nurses United

MINNEAPOLIS—The 589 doctors at Minnesota’s Allina Health Care chain were onto something when they voted in late 2022 to unionize with the Service Employees:

When hospital chains privatize in pursuit of profits, the quality of patient care goes down—way down–compared to a control group of other hospitals, a new study shows. Outcomes after discharge are worse.

Which is what the Minnesota doctors said and National Nurses United has said for years.

There are 27.3% more patient falls in the for-profit hospitals. “Central line-associated bloodstream infections” rose 37.7% a summary of the study said. That’s even though the patients in the for-profit hospitals were younger than those in the larger control group.

Wait, the numbers get even worse when patients are taken in for surgery at the private-equity for-profit hospitals.

“Surgical site infections doubled from 10.8 to 21.6 per 10, 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume,” the study added.

“Meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations.”

About the only number that didn’t change in comparing the two groups of hospitals was the percentage of patients who died.

Don’t believe us? Well, don’t take our word for it. The study was in the December issue of the Journal of the American Medical Association, or JAMA.

Which, given the AMA’s history, is amazing.

For decades, the AMA was a bastion of so-called “free market capitalism” in health care. It even opposed Medicare before finally coming around—with a limited program of its own—after Lyndon Johnson’s 1964 election landslide. Johnson pushed Medicare, which was floating around Congress for years, to fruition in 1965.

“There was only a limited amount of experience with large-scale, nationwide, health reimbursement programs,” Johnson’s Health, Education and Welfare Secretary, Wilbur Cohen, wrote 20 years later. For decades he’d been working to craft Medicare.

“There was a good deal of rhetoric and little empirical information. There was an extensive outpouring of ideology and a limited amount of research,” Cohen added.

Adds to the information

Now the JAMA study adds to the information and research.

But there’s still the ideology to overcome, National Nurses United reports.

Ascension Health Care System hospitals in Wichita, Kansas, and Austin, Texas, for example, forced their hundreds of nurses to strike in December over cuts in patient care—in what is supposedly a non-profit Catholic-run health care system.

“Ascension has failed to invest its resources–including the tens of millions of dollars it does not pay in federal taxes, due to its nonprofit status–back into its communities and workforce,” NNU said then. It was only the latest of such forced short strikes over patient care which NNU members staged.

Many doctors still complain Medicare doesn’t pay them enough when they treat you. Maybe they ought to stand up to their boardroom bosses, instead. That’s what Allina’s 589 MDs in the 60-facility chain in Minnesota did, unionizing with SEIU’s Committee of Interns and Residents.

JAMA’s study backs their stand, and that of residents at Stanford Hospital, the University of Southern California hospital system, and the University of Vermont, who have also unionized.

In a difference-in-differences examination of 662,095 hospitalizations at 51 private equity–acquired hospitals and 4,160,720 hospitalizations at 259 matched control hospitals using 100% Medicare Part A claims data, private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions,” JAMA’s summary says. Medicare Part A covers hospital stays.

“Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals…These findings heighten concerns about the implications of private equity on health care delivery,” JAMA understated.

Of course, when the Allina MDs unionized, they had similar complaints, adding that health insurers—and their own hospital bosses, in pursuit of profits—loaded them down with paperwork, too. And insurers often reject care requests from docs, they said then.

Key issues in the organizing drive among the docs echo those by nurses’ unions, notably the National Nurses United, the main union for RNs, and a strong nurses’ union in Minnesota.

“Allina clinicians complain of unrealistic productivity demands and increasing bureaucratic tasks that force them to churn through patients with few support staff,” the Minnesota Reformer reported in 2022.

“One recent study found family medicine physicians spend more than half their time on paperwork—six hours out of their average 11-hour day. Allina clinicians say burnout is high, and a union will give them a collective voice to advocate for working conditions that will improve care for patients,” the Reformer added.

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Mark Gruenberg
Mark Gruenberg

Award-winning journalist Mark Gruenberg is head of the Washington, D.C., bureau of People's World. He is also the editor of the union news service Press Associates Inc. (PAI). Known for his reporting skills, sharp wit, and voluminous knowledge of history, Mark is a compassionate interviewer but tough when going after big corporations and their billionaire owners.