Patients treated at for-profit hospitals died and returned to hospital more often than patients at nonprofit hospitals, and nurses at for-profit hospitals were far more likely to describe their workloads as unsafe, according to a University of Pennsylvania School of Nursing study published in Medical Care and reported by Penn Nursing, Beckers Hospital Review and MedicalXpress.
Researchers at Penn Nursings Center for Health Outcomes and Policy Research and the Leonard Davis Institute of Health Economics studied more than 1.17 million patients across 143 for-profit and 798 nonprofit adult acute care hospitals in 10 states. The analysis drew on 2024 Medicare admissions data and survey responses from 17,368 bedside registered nurses.
The outcome gaps were consistent. Compared with nonprofit hospitals, for-profit hospitals recorded roughly 11 additional deaths per 1,000 medical admissions and 5 additional deaths per 1,000 surgical admissions. Thirty-day readmissions were 2.04 percentage points higher for medical patients and 1.76 percentage points higher for surgical patients, which works out to roughly 20 additional readmissions per 1,000 medical discharges and 18 per 1,000 surgical discharges. Patients also gave for-profit hospitals lower overall ratings.
Nurse staffing sat at the center of the findings. At for-profit hospitals, 71 percent of nurses said their assigned patient workloads were not safe, compared with 54 percent at nonprofit hospitals. In the researchers analysis, staffing differences accounted for a meaningful share of the gaps, including about 40 percent of the medical mortality difference and 45 percent of the surgical mortality difference, 16 percent of the medical readmission gap and 30 percent of the surgical readmission gap, and about two-thirds of a 9-percentage-point difference in nurse burnout. Fifty-one percent of nurses at for-profit hospitals said they would not recommend their hospital to family, compared with 26 percent at nonprofit hospitals.
Lead author Matthew D. McHugh of Penn Nursing argued that safe staffing should be treated as a core component of quality rather than a discretionary operating expense, especially where incentives to cut labor costs are strongest. The authors concluded that minimum safe staffing requirements and greater transparency about hospital ownership could improve outcomes for patients and nurses.
The study is observational, so it does not prove that profit status itself causes worse outcomes, and hospitals differ in the patients and resources they bring to the comparison. Even so, the authors say staffing is a lever that policy and management can actually move, which makes the link between ownership, nurse workloads and patient results a practical concern for regulators, hospital leaders and families choosing where to seek care. This report summarizes published research and is not guidance for any individuals treatment decisions.
The study lands in a long policy argument about what hospital ownership means for care. The number of for-profit hospitals in the United States has grown as health systems consolidate, and regulators increasingly ask whether staffing models are part of how ownership shows up at the bedside. Nurse staffing is one of the few quality factors that can be measured consistently across hundreds of hospitals, from the number of patients per nurse to nurses own reports of whether assignments felt safe.
Patients rating the hospitals pointed in the same direction as the clinical measures, with overall ratings 4.45 percentage points lower at for-profit hospitals and staffing accounting for part of that gap. The researchers frame the remedy in operational terms rather than ownership bans: set and enforce minimum safe staffing levels, and make ownership transparent so patients, purchasers and regulators can see who operates a hospital. Their argument is that if staffing explains a substantial share of outcome differences, then staffing policy is a quality policy regardless of who owns the building.
