Rehabilitation Care: Performance and Ownership

Background: Is there any difference in performance based on ownership of rehabilitation structures? In France, they can be private for-profit, non-profit or public. The type of ownership impacts the activity of the rehabilitation unit (as a public service mission), the management of healthcare institution staff and the institution healthcare's organization. As a consequence, it may affect the performance. However, what do we mean by performance? This indicator is, in fact, multidimensional. We propose 5 outcomes as performance indicators based on a literature survey. Methods: We consider six samples set up on the frequency of Major Diagnostic Category (MDC) stays. As a sensitivity analysis, we also set up samples for stroke, chronic obstructive pulmonary disease (COPD), heart failure, and total hip replacement. We run incremental four models on these samples. Results: For-profit hospitals appear to provide better performance than other types of hospital ownership. Patient characteristics and hospital equipment as well as number of medical staff and non-medical staff explain part of differences in performance based on ownership. It remains that for-profit rehabilitation unit perform better in terms of probability of death, probability to return-to-home and improvement in both, physical score and cognitive score. This result is obtained with a more efficient patient care (less daily care's activity per patient measured as rr-score). Considering separately Research public hospital from other public hospital centre, results obtained are very heterogeneous. Conclusion: The performance level differs from type of ownership to the other. For-profit rehabilitation's centres get better results, with control for patient's heterogeneity of demographic aspects and level of severity. However, we do not control for the social vulnerability that impacts the profit of rehabilitation units. That raises the political question on the role of healthcare centres to support social vulnerability.