higher acute care (and rehabilitation4) hospital payments are not the whole story on investor-owned care. For-profit hospitals and dialysis clinics have high death rates.5,6 Investor-owned nursing homes are more frequently cited for quality deficiencies and provide less nursing care,7and investor-owned hospices provide less care to the dying,8than non-for-profit facilities.

fraud, the payment of kickbacks to physicians and overbilling of Medicare

For-profit executives reap princely rewards, draining money from care.

Investor-owned hospitals spend much less on nursing care than not-for-profit hospitals, but their administrative costs are 6 percentage points higher14

High administrative costs and lower quality have also characterized for-profit HMOs,15 now the dominant private insurers in the United States. Such plans take 19% for overhead, versus 13% in non-profit plans, 3% in the US Medicare program and 1% in Canadian medicare.16,17

Why do for-profit firms that offer inferior products at inflated prices survive in the market? Several prerequisites for the competitive free market described in textbooks are absent in health care.19,20

Privatization creates vast opportunities for powerful firms, and also redistributes income among health workers. Pay scales are relatively flat in government and not-for-profit health institutions; pay differences between the CEO and a housekeeper are perhaps 20:1. In US corporations, a ratio of 180:1 is average.22 In effect, privatization takes money from the pockets of low-wage, mostly female health workers and gives it to investors and highly paid managers.

in most instances, it was considerably more expensive because of the private sector's built-in profit.

if it can be proven and accurately substantiated that the private sector delivering public services is less expensive, that it's more efficient and timely, and is of high quality, and it doesn't remove professionals or money from the public system and thus weaken public health care, then I think most Canadians, being practical people, would approve.

There are some cases where these principles can be met.

cette pratique mixte, qui n'est permise qu'aux radiologistes

le ministre veut que l'assurance maladie couvre les frais des échographies et des endoscopies réalisées dans le privé à l'avenir

MPs repeatedly challenged the minister to accept there was a funding crisis in social care, warning that this could undermine integration and possible reforms such as those recommended by the Dilnot Commission on Funding of Care and Support, published last year.

some experts estimated that 900 000 people in the UK were left without basic care.

The health committee is due to report its findings on social care before the government publishes a white paper on care and support in the spring.

Although outsourcing has grown steadily since the 1990s, expectations of an austerity-induced boom have so far disappointed, with some local authorities even deciding to insource services to address concerns that privatisation was not proving the best value for taxpayers’ money.

Cumbria council has recently agreed to repatriate 300 staff outsourced to Amey after its seven-year contract to provide highways maintenance comes to an end in April, while Rotherham and Ealing councils both insourced highways services last year.

Last year, Edinburgh council also decided against privatising the city’s bin collection and street cleaning services.

The SNP government has ruled out any privatisation of the National Health Service, but local authorities are free to consider outsourcing if they believed that would improve delivery of services, added the SNP government

According to the Open Public Services white paper published last year, at least 40 per cent of local authority spending goes on contracts to the private and voluntary sectors; almost half of all councils have outsourced refuse collection while 55 per cent of social housing is provided by housing associations.

The International Federation of Health Plans, in its 2010 comparative price report, documented just how large the price differential can be for a wide range of services.

Americans can see a specialist or get elective surgery a lot faster than patients in other countries, according to surveys by the Commonwealth Fund.

The surveys also show that Americans are more likely than people in other advanced nations to experience medical errors or problems with uncoordinated care, and to forgo care because it’s too expensive.

we have alarmingly high rates of hospital admissions for asthma and uncontrolled diabetes — an indicator that many patients don’t have good primary care

The rise of medical tourism to glittering hospitals in places like Singapore and Thailand has turned coddling and elegance into marketing necessities

The spotlight on luxury accommodations comes at an awkward time for many urban hospitals, now lobbying against cuts in Washington and highlighting their role as nonprofit teaching institutions that serve the poor.

In space-starved New York, many regular hospital rooms are still double-occupancy

“We pride ourselves on getting anything the patient wants. If they have a craving for lobster tails and we don’t have them on the menu, we’ll go out and get them.”

30 percent of its clientele comes from abroad

“I’m perfectly at home here — totally private, totally catered,” she added. “I have a primary-care physician who also acts as ringmaster for all my other doctors. And I see no people in training — only the best of the best.”

Increasingly, hospitals serving the merely well-off are joining the amenities race.

The conflicts echo those of a century ago, in another era of growing income inequality and financial crisis, said David Rosner, a professor of public health and history at Columbia University. Hospitals, founded as free, charitable institutions to rehabilitate the poor, began seeking paying patients for the first time in the 1890s, he said, restyling themselves in part as “hotels for rich invalids.”

“Every generation of hospitals reflects our attitude about health and disease and wealth and poverty,” Professor Rosner said. “Today, they pride themselves on attracting private patients, and on the other hand ask for our tax dollars based upon their older charitable mission. There’s a conflict there at times.”

Canada would benefit from a coordinated approach to price determination.

The rate of spending on health in Canada is rising faster than the rate of economic growth, creating concerns about the sustainability of Canada’s publicly funded healthcare systems. Expenditures on drugs is one of the fastest-growing areas.