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Open heart surgery in public and private practice.

J Pons1, V Moreno, J Borras

  • 1Catalan Agency for Health Technology Assessment (Agència d'Avaluació de Tecnología Medica), Catalan Health Service, Barcelona, Spain.

Journal of Health Services Research & Policy
|July 1, 1999
PubMed
Summary

Public and private hospitals in Catalonia showed differences in open heart surgery patient risk and outcomes. After adjusting for patient complexity, surgical mortality rates were similar between public and private providers.

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Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Public Health Policy

Background:

  • Public and private hospitals offer open heart surgery services in Catalonia, Spain.
  • Patient case mix, procedures, and surgical mortality may differ between these providers.
  • Understanding these differences is crucial for evaluating healthcare quality and equity.

Purpose of the Study:

  • To compare open heart surgery services in public versus private hospitals in Catalonia.
  • To analyze differences in patient case mix, surgical procedures, and mortality rates.
  • To determine if provider type influences surgical outcomes after adjusting for patient risk.

Main Methods:

  • Prospective data collection on 1287 adult open heart surgery procedures over 6.5 months in 1994.

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  • Inclusion of sociodemographic, clinical, and procedural variables.
  • Utilized a predictive model to adjust for surgical mortality risk and case mix differences.

    • Main Results:

    • Significant differences observed in patient demographics, clinical history, and procedures between public and private centers.
    • Higher-risk patients were more likely to be treated in public centers.
    • Crude surgical mortality rates varied, but after adjusting for case mix, the difference between public and private providers was not statistically significant (OR 1.68; 95% CI 0.94-3.0).

    Conclusions:

    • Crude mortality rates differ between public and private providers, with higher surgical risk in public centers.
    • Adjusting for surgical risk significantly reduced and eliminated statistically significant differences in mortality between provider types.
    • Socioeconomic factors, like educational level, may influence patient selection and contribute to observed differences in surgical risk and performance.