Two decades of research comparing for-profit and nonprofit health provider performance in the United States

Objective. This article reports on a systematic review of data-based, peer-reviewed scientific assessments of performance differences between private for-profit and private nonprofit U.S. health care providers published since 1980. Methods.' Computerized bibliographic searches of all relevant databases yielded 149 studies (179 assessments) that compared the performance of for-profit and nonprofit health care providers on four performance criteria (access, quality, cost/efficiency, and/or amount of charity care). Reported findings on performance were coded in one of three ways: for-profit superiority, nonprofit superiority, or no difference/mixed results. Results. Overall, the nonprofits were judged superior 59 percent of the time, the for-profits superior only 12 percent of the time, and for the rest (29 percent), no difference was found or results were mixed. Conclusions. Caution is warranted on policies that encourage private for-profit entities to replace private nonprofit providers of health care services in the United States.