Intended for healthcare professionals


Should doctors own hospitals?

BMJ 2015; 351 doi: (Published 02 September 2015) Cite this as: BMJ 2015;351:h4615
  1. John A Romley, associate professor of research
  1. 1Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
  1. romley{at}

Financial incentives for physician owners can work against patients’ best interests

In the United States, nearly four out of five hospitals are private. As of 2010, more than 200 of these private hospitals were owned by doctors. In that same year the US Congress passed and President Obama signed into law the Affordable Care Act, a comprehensive package of healthcare reforms that prohibited (with limited exceptions) further development of “physician owned hospitals” (POHs).

The American Hospital Association supported this prohibition, stating: “When a doctor self-refers a patient to a hospital in which he or she is invested, that is fundamentally the wrong incentive and leads to the wrong behavior.”1

From this critical perspective, the linked paper by Blumenthal and colleagues (doi:10.1136/bmj.h4466) examines the performance of POHs in the US in 2010.2 Specifically, the authors compared the quality of care, cost of care, and patient population at POHs with those at non-POHs located within the same hospital referral regions.

Overall, POHs look largely benign in this study. In terms of quality, POHs were indistinguishable from non-POHs in the same region in a publicly reported patient satisfaction survey, and in the provision of appropriate care for patients with heart attack, heart failure, and …

View Full Text

Log in

Log in through your institution


* For online subscription