Evidence map›Paper›PMID 29886441›Full record

ArticleBMJ open2018

Which patients receive surgery in for-profit and non-profit hospitals in a universal health system? An explorative register-based study in Norway.

Geir Hiller Holom, Nina Alexandersen, Jeremy D Goldhaber-Fiebert, Terje P Hagen

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. The Eye-Opening Truth About Private Surgical Facilities in Canada.Healthcare policy = Politiques de sante · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 2 countries.

Geir Hiller HolomDepartment of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway.
Nina AlexandersenDepartment of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway.
Jeremy D Goldhaber-FiebertCenter for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA.
Terje P HagenDepartment of Health Economics and Health Management, Institute of Health and Society, University of Oslo, Oslo, Norway.
Stanford University · USUniversity of Oslo · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo compare the socioeconomic status (SES) and case-mix among day surgical patients treated at private for-profit hospitals (PFPs) and non-profit hospitals (NPs) in Norway, and to explore whether the use of PFPs in a universal health system has compromised the principle of equal access regardless of SES.

designA retrospective, exploratory study comparing hospital types using the Norwegian Patient Register linked with socioeconomic data from Statistics Norway by using Norwegian citizens' personal identification numbers.

settingThe Norwegian healthcare system. POPULATION: All publicly financed patients in five Norwegian metropolitan areas having day surgery for meniscus (34 100 patients), carpal tunnel syndrome (15 010), benign breast hypertrophy (6297) or hallux valgus (2135) from 2009 to 2014. PRIMARY OUTCOME MEASURE: Having surgery at a PFP or NP.

resultsAcross four unique procedures, the adjusted odds ratios (aORs) for using PFPs were generally lower for the lowest educational level (0.77-0.87) and the lowest income level (0.68-0.89), though aORs were not always significant. Likewise, comorbidity and previous hospitalisation had lower aORs (0.62-0.95; 0.44-0.97, respectively) for having surgery at PFPs across procedures, though again aORs were not always significant. No clear patterns emerged with respect to age, gender or higher levels of income and education.

conclusionsThe evidence from our study of four procedures suggests that equal access to PFPs compared with NPs for those patients at the lowest education and income levels may be compromised, though further investigations are needed to generalise these findings across more procedures and probe causal mechanisms and appropriate policy remedies. The finding that comorbidity and previous hospitalisation had lower odds of treatment at PFPs indicates that NPs play an essential role for more complex patients, but raises questions about patient preference and cream skimming.

Indexed as

Educational StatusIncomeAdolescentAdultAgedAged, 80 and overFemaleHospitalizationHospitals, ProprietaryHumansMaleMiddle AgedNorwayOrganizations, NonprofitPatient Acceptance of Health CarePatient Preferencecase-mixhealth policyhealth services researchprivate hospitals

Identifiers

PMID29886441
PMCPMC6009459
OpenAlexW2805756844

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.