The burdens of low-value care in hysterectomy attributable to hospital ownership in China

Abstract

Abstract Scholarly attention has been dedicated to the identification of low-value care (care that is not expected to provide a net benefit). Despite a consensus on the importance of hospital characteristics in explaining the use of low-value care, the precise influence of hospital ownership, herein the distinction between public and private ownership, remains unclear. This study included 38,865 hospital discharge records with hysterectomy procedures in China from 2016 to 2020 to describe the effect of public and private hospital ownership on the provision of low-value care and estimate the attributable risk ratio and corresponding attributable burden. Private hospitals were more likely to provide low-value hysterectomies, with the average incremental effect of 33.7% (95% CI, 23.5–42.5%). Potential interventions in private hospitals could reduce this a maximum of 9.7% (95% eCI, 8.7–10.4%) of low-value hysterectomy cases, corresponding to 48,375 (95% eCI, 43,254, to 51,706) annual cases and 1.82 (95% eCI, 1.63 to 1.94) billion USD costs nationally. For the first time, we identified the potential intervention target and estimated the maximum effectiveness of interventions to eliminate excessive risk of low-value care.