Profit Before Patients: Study Ties For-Profit Hospital Care to Higher Death Rates and Nurse Shortages

A sweeping new analysis of hospital care in the United States has found that patients treated at for-profit hospitals face measurably higher risks of dying or being readmitted after discharge than patients treated at nonprofit institutions, and that the gap is closely tied to how many nurses are available at the bedside. The study, led by researchers at the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research and the Leonard Davis Institute of Health Economics, was published open access in the journal Medical Care. It arrives at a moment when hospital corporatization and profit-driven models of health care delivery are expanding across the country, raising urgent questions about whether financial incentives are quietly eroding the foundations of safe care.

The scale of the investigation lends considerable weight to its conclusions. The research team examined the outcomes of more than 1.17 million patients treated at 143 for-profit and 798 nonprofit adult acute care hospitals across 10 states. By drawing on such a large patient population and a substantial share of hospitals in each ownership category, the researchers were able to compare mortality, readmission, and patient experience measures across ownership types while accounting for differences in nurse staffing, the factor that emerged as a central explanation for the quality divide. The findings suggest that the ownership structure of a hospital is not merely an administrative detail but a variable with tangible consequences for the people it treats.

The mortality differences were stark. 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. For medical patients, differences in nurse staffing were identified as a main explanation for the higher mortality observed in for-profit settings. In other words, a meaningful portion of the excess deaths was associated not with the complexity of the patients themselves but with the conditions under which nurses were working, particularly the number of patients each nurse was assigned to care for at one time. This distinction matters because staffing levels are, unlike many drivers of surgical outcomes, directly amenable to policy and management decisions.

Readmission rates told a parallel story. Thirty-day readmissions were 2.04 percentage points higher for medical patients and 1.76 percentage points higher for surgical patients at for-profit hospitals, which translates to roughly 20 additional readmissions per 1,000 medical discharges and 18 per 1,000 surgical discharges. Differences in nurse staffing accounted for 16 percent of the readmission gap among medical patients and 30 percent of the gap among surgical patients. Readmissions are widely used as a quality indicator because they often signal that a patient left the hospital without adequate recovery support, discharge planning, or in-hospital care that fully addressed their condition. The finding that staffing explains a substantial share of these differences points to a modifiable pathway through which hospital ownership may influence patient trajectories after discharge.

Patients themselves appeared to sense the difference. Individuals treated at for-profit hospitals rated their institutions lower overall than patients at nonprofit hospitals did, and worse nurse staffing accounted for the lower overall hospital ratings. Patient ratings are not simply measures of satisfaction with amenities or food; decades of research have linked patients’ assessments of their hospital care, particularly their confidence in nursing care, to objective outcomes including mortality and readmission. That patient perceptions aligned with the hard clinical endpoints in this study strengthens the argument that the staffing shortfalls documented by nurses were visible in the everyday experience of care.

The consequences for the nursing workforce were equally concerning. Nurses in for-profit hospitals reported markedly worse staffing conditions, with 71 percent saying their assigned patient workloads were not safe. Nurse burnout was significantly higher in for-profit hospitals, and nurses working in them were far less likely to recommend their hospital to family and friends, either as a place to receive care or as a place to work, because of concerns about poorer staffing. These findings matter beyond workforce statistics. Burnout and unsafe workloads are known drivers of turnover, and turnover compounds understaffing in a self-reinforcing cycle that can degrade care quality over time. A hospital that cannot retain experienced nurses faces rising costs and mounting risks to patients simultaneously.

Lead author Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, the Independence Chair for Nursing Education, Professor of Nursing, and Director of the Center for Health Outcomes and Policy Research at Penn Nursing, as well as a Senior Fellow at the Leonard Davis Institute of Health Economics, framed the implications in pointed terms. Treating safe nurse staffing as a core component of quality rather than a discretionary operating expense is especially important where incentives to cut labor costs are strongest, he said. Minimum safe staffing requirements and ownership transparency are practical safeguards for patients and nurses, he added. The statement underscores the study’s central policy argument: because labor is one of the largest controllable expenses in a hospital budget, ownership models that prioritize profit margins have both the incentive and the opportunity to trim nursing resources, and the evidence suggests that some do.

The research was conducted with co-authors Karen B. Lasater, PhD, K. Jane Muir, PhD, Trissa Lyman, MPH, Angelo Petto, BSN, and Linda H. Aiken, PhD, several of whom are fellows of both the Center for Health Outcomes and Policy Research and the Leonard Davis Institute of Health Economics. The work was supported by the National Institute of Nursing Research of the National Institutes of Health under grant award numbers R01NR014855, T32NR007104, and R01NR021707. The study, titled Patient Outcomes and Nurse Understaffing in For-Profit Hospitals, carries the DOI 10.1097/MLR.0000000000002376 and is available open access, allowing clinicians, policymakers, and the public to examine the evidence directly.

The authors conclude that policies establishing minimum safe nurse staffing requirements and enhancing hospital ownership transparency could meaningfully improve patient, nurse, and hospital outcomes. Such conclusions carry particular relevance as state legislatures across the country debate mandated nurse-to-patient ratios and as regulators scrutinize private equity investment and corporate consolidation in health care. The study suggests that investments in nursing and state policies establishing safe staffing requirements are important and actionable mechanisms to ensure patient safety, nurse retention, and quality of care for patients regardless of the ownership type of their hospital. In practical terms, this means that the quality gap documented between for-profit and nonprofit hospitals is not an inevitability of ownership structure but a consequence of resource allocation decisions that regulation could influence.

The findings also connect to a growing body of research on hospital ownership and nursing investment, including a 2025 study by Muir and colleagues published in Medical Care showing that hospital ownership type correlated with investments in nursing services using evidence from Illinois. Taken together, this line of inquiry points toward a consistent conclusion: where the profit motive is strongest, nursing resources tend to be thinnest, and patient outcomes suffer as a result. For a health system grappling with nurse shortages, rising burnout, and intensifying corporate ownership of care delivery, the study offers a clear and testable proposition. Protecting staffing levels, whether through legislation, accreditation standards, or transparency requirements that let patients see how hospitals are resourced, may be one of the most direct levers available for improving the safety of American hospital care.

Subject of Research: The relationship between hospital ownership type, nurse staffing levels, and patient outcomes in US acute care hospitals

Article Title: For-profit hospitals linked to worse patient outcomes and nurse staffing shortfalls, new Penn Nursing study finds

Article References: For-profit hospitals linked to worse patient outcomes and nurse staffing shortfalls, new Penn Nursing study finds. (n.d.). Original publication

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Keywords: for-profit hospitals, nurse staffing, patient outcomes, mortality, readmissions, hospital ownership, nurse burnout, Penn Nursing, Medical Care, health policy, patient safety, staffing requirements