Posted on Nov. 20: Major study finds patients more likely to die in private for-profit dialysis centres

[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/Devereaux_Peter.jpg” caption=”Philip Devereaux”]If Canada switched to for-profit dialysis centres, death rates would increase by eight per cent, according to a major study to be published today in the Journal of the American Medical Association (JAMA).

“The results extend our previous findings of higher death rates in for-profit hospitals,” said the study's lead author, Philip Devereaux of McMaster University. “We've now found that the profit motive leads to increased deaths in both hospital and out-patient settings.” Devereaux, a clinical scholar in the Department of Medicine in the Faculty of Health Sciences, was the lead investigator on the study.

The systematic review and meta-analysis compared death rates in more than 500,000 adult patients receiving care in either for-profit or not-for-profit American dialysis facilities. Dialysis is a common medical treatment for kidney conditions. The results were consistent across studies, and indicate that if American patients received care in private not-for-profit dialysis facilities instead of for-profit facilities, approximately 2,500 lives or eight per cent would be saved each year from the 31,000 deaths.

Approximately 12,700 Canadians receive hemodialysis each year, of which 1,970 die. “If Canada converted its private not-for-profit dialysis centres to private for-profit centres, we could expect approximately 150 additional deaths each year,” says Devereaux.

“The results are not difficult to explain,” says Devereaux. “Private for-profit facilities have to generate profits to satisfy shareholders and pay taxes, and typically these two expenditures are in the range of 10 to 15 per cent of expenses. Not-for-profit facilities can spend this money on patient care. The higher death rates result when for-profit companies cut corners to make sure they produce the required profit margin.”

The results of this review are directly relevant to Canada, said Devereaux. First, the studies included patients receiving publicly financed care in private not-for-profit and private for-profit dialysis facilities, a situation identical to what Canadian policy-makers have been considering. Second, the results are consistent over an eight-year time period despite changes in American health care (such as the introduction of managed care and HMOs). Third, if Canada moved to for-profit dialysis facilities, the same large American dialysis chains included in the review would be purchasing Canadian dialysis facilities.

“We have shown a major increase in death rates,” Devereaux concluded. “Our results should raise serious concerns about moves to private for-profit care, whether in hospitals, day surgeries, or other outpatient facilities. It is time to move health care policy debate away from ideology and into the evidence-based era.”