Medicare
========

* John Hoey

**[The editor-in-chief responds:]** 

Perhaps Brian Day, in criticizing our editorial,1 should reread the referenced paper.2 Although that piece focused on the debacle of for-profit managed care in the US we could also draw Day's attention to studies specific to the question of hospital ownership. These show, for example, that US medicare spending in 1995 in for-profit markets resulted in $5.9 billion in excess costs when compared with spending in not-for-profit markets.3 Privately financed care costs considerably more than equivalent publicly financed care.

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## References

1.  1. Klein's surgical strke at medicare [editorial]. CMAJ 2000;162(3):309.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjIvMy8zMDkiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTYyLzgvMTEyNS4zLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Rough seas in US managed care [editorial]. CMAJ 1999;161(6):669.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjEvNi82NjkiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTYyLzgvMTEyNS4zLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  3. Silverman EM, Skinner JS, Fisher ES. The association between for-profit hospital ownership and increased medicare spending. N Engl J Med 1999;341:420-6.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJM199908053410606&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10432327&link_type=MED&atom=%2Fcmaj%2F162%2F8%2F1125.3.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000081860100006&link_type=ISI)