Does Nature of Hospital Financing Influence Early Mortality After Coronary Artery Bypass Grafting

Abstract

The aim of public health systems is to ensure that patients receive effective and efficient health care within a reasonable period. In Spain, running of the health care system has recently been transferred to the autonomous regions. Most of these regions have sufficient infrastructure to cover the needs of their population for the most common cardiovascular diseases such as ischemic heart disease. However, some health systems still refer a variable number of their patients to hospitals in the private sector, either referring patients for certain specialties to a private center or referring patients directly from waiting lists for public hospitals. The reasons for such referrals are usually excessive time spent on the waiting list or certain shortcomings in the number or facilities of public hospitals in certain regions. Comparison of the cost and the outcomes of care processes in public and private hospitals has always been subject to controversy. This comparison is fully justified, and indeed is an obligation when the public health service finances operations in private hospitals. In an article in this issue of the journal, Ribera et al1 publish the results of a study financed by the Catalonian public health system. The study compared early mortality after coronary artery bypass grafting (CABG) in patients from the public health system who underwent operations in both public and private hospitals. They then compared the results with those of a similar study published 6 years ago.2 Although the objective is worthy of praise, objective comparison between the public and private sectors for outcomes is difficult because substantial structural and functional differences exist between the 2 systems and these differences effect to a greater or lesser extent the individual outcomes of the health care. Does Nature of Hospital Financing Influence Early Mortality After Coronary Artery Bypass Grafting