ReviewEffects of physician-owned specialized facilities in health care: A systematic review

•Review of the available evidence on the effects of physician-owned specialized facilities.•Examine quality and cost at physician-owned facilities and their impact on full-service general hospitals.•Little evidence exists in favour of physician-owned specialized facilities.•Impact on the performance of full-service general hospitals remains limited.•The development of physician-owned specialized facilities should be monitored carefully.

BackgroundMultiple studies have investigated physician-owned specialized facilities (specialized hospitals and ambulatory surgery centres). However, the evidence is fragmented and the literature lacks cohesion.ObjectivesTo provide a comprehensive overview of the effects of physician-owned specialized facilities by synthesizing the findings of published empirical studies.MethodsTwo reviewers independently researched relevant studies using a standardized search strategy. The Institute of Medicine's quality framework (safe, effective, equitable, efficient, patient-centred, and accessible care) was applied in order to evaluate the performance of such facilities. In addition, the impact on the performance of full-service general hospitals was assessed.ResultsForty-six studies were included in the systematic review. Overall, the quality of the included studies was satisfactory. Our results show that little evidence exists to confirm the advantages attributed to physician-owned specialized facilities, and their impact on full-service general hospitals remains limited.ConclusionAlthough data is available on a wide variety of effects, the evidence base is surprisingly thin. There is no compelling evidence available demonstrating the added value of physician-owned specialized facilities in terms of quality or cost of the delivered care. More research is necessary on the relative merits of physician-owned specialized facilities. In addition, their corresponding impact on full-service general hospitals remains unclear. The development of physician-owned specialized facilities should thus be monitored carefully.