How nonprofits matter in American medicine, and what to do about it

Health Affairs

Volumn 25, Issue 4, 2006, Pages

  Schlesinger, Mark ^a   Gray, Bradford H ^b  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CLASSIFICATION; COMPARATIVE STUDY; ECONOMICS; HEALTH SERVICES RESEARCH; HOSPITAL; HUMAN; MANAGEMENT; NON PROFIT HOSPITAL; ORGANIZATION AND MANAGEMENT; PUBLIC RELATIONS; REVIEW; TAX; UNITED STATES;

COMMUNITY-INSTITUTIONAL RELATIONS; HEALTH SERVICES RESEARCH; HOSPITALS, PROPRIETARY; HOSPITALS, VOLUNTARY; HUMANS; OWNERSHIP; POLICY MAKING; TAX EXEMPTION; UNITED STATES;

EID: 33746918697     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.w287     Document Type: Review

References (105)

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2. J.R. Horwitz, "Why We Need the Independent Sector: The Behavior, Law, and Ethics of Not-for-Profit Hospitals," UCLA Law Review 50, no. 6 (2003): 1345-1411 (quote, p. 1346).
3. See, for example, T. Reeves and E. Ford, "Strategic Management and Performance Differences: Nonprofit versus For-Profit Health Organizations," Health Care Management Review 29, no. 4 (2004): 298-308.
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5. John Colombo, University of Illinois College of Law, testimony before the House Ways and Means Committee, 26 May 2005, http://waysandmeans.house.gov/ hearings.asp?formmode=view&id=2713 (accessed 10 March 2006).
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13. We did not include studies examining organizations converting from one form of ownership to the other because such facilities typically are not representative of nonprofit and for-profit providers of that service.
14. Shen et al., "Hospital Ownership";
15. Devereaux et al., "Payments for Care";
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19. J. Ballou, "The Role of the Not-for-Profit Firm in the Mixed Industry: Three Empirical Analyses of the Long-Term Care and Hospital Industries" (Doctoral thesis, Northwestern University, 2000);
20. Rosenau and Linder, "A Comparison";
21. B. Dickey, "A Comparison of For-Profit and Not-for-Profit Hospitals on the Cost of Mental Health Admissions," Harvard Review of Psychiatry 2, no. 2 (1994): 97-103;
22. M.J. McCue and J.P. Clement, "Relative Performance of For-Profit Psychiatric Hospitals in Investor-Owned Systems and Nonprofit Psychiatric Hospitals," American Journal of Psychiatry 150, no. 1 (1993): 77-82;
23. J.R. Wheeler, H. Fadel, and T.A. D'Aunno, "Ownership and Performance of Outpatient Substance Abuse Treatment Centers," American Journal of Public Health 82, no. 5 (1992): 711-718;
24. M.J. McCue and J.M. Thompson, "Association of Ownership and System Affiliation with the Financial Performance of Rehabilitation Hospitals," Health Services Management Research 10, no. 1 (1997): 13-23;
25. Treo Solutions, "Costs, Commitment, and Locality: A Comparison of For-Profit and Not-for-Profit Health Plans," Inquiry 41, no. 2 (2004): 116-129;
26. and M. Schlesinger, D. Blumenthal, and E. Schlesinger, "Profits under Pressure: The Economic Performance of Investor-Owned and Nonprofit Health Maintenance Organizations," Medical Care 24, no. 7 (1986): 615-627.
27. M. Schlesinger et al., "Profit-Seeking, Corporate Control, and the Trustworthiness of Health Care Organizations: Assessments of Health Plan Performance by Their Affiliated Physicians," Health Services Research 40, no. 3 (2005): 605-645;
28. E. Silverman and J. Skinner, "Medicare Upcoding and Hospital Ownership," Journal of Health Economics 23, no. 2 (2004): 369-389;
29. J.L. Troyer and H.G. Thompson, "The Impact of Litigation on Nursing Home Quality," Journal of Health Politics, Policy and Law 29, no. 1 (2004): 11-42;
30. C.E. Johnson et al., "Predicting Lawsuits against Nursing Homes in the United States, 1997-2001," Health Services Research 39, no. 6, Part 1 (2006): 1713-1731;
31. B.A Weisbrod and M. Schlesinger, "Ownership Formand Behavior in Regulated Markets with Asymmetric Information," in The Nonprofit Sector: Economic Theory and Public Policy, ed. S. Rose-Ackerman (New York: Oxford University Press, 1986), 133-151;
32. T.L. Mark, "Psychiatric Hospital Ownership and Performance: Do Nonprofit Organizations Offer Advantages in Markets Characterized by Asymmetric Information?" Journal of Human Resources 31, no. 3 (1996): 631-649;
33. S.Y. Chou, "Asymmetric Information, Ownership, and Quality of Care: An Empirical Analysis of Nursing Homes," Journal of Health Economics 21, no. 2 (2002): 293-311;
34. and H.T. Tu and J.D. Reschovsky, "Assessments of Medical Care by Enrollees in For-Profit and Nonprofit Health Maintenance Organizations," New England Journal of Medicine 346, no. 17 (2002): 1288-1293.
35. M. Schlesinger and B.H.Gray, "Nonprofit Organizations and Health Care: The Paradoxes of Persistent Attention," in The Nonprofit Sector: A Research Handbook, 2d ed., ed. W.W. Powell and R. Steinberg (New Haven, Conn.: Yale University Press, forthcoming).
36. Horwitz, "Why We Need the Independent Sector";
37. and A. Malani, T. Philpson, and G. David, "Theories of Firm Behavior in the Nonprofit Sector: A Synthesis and Empirical Evaluation," in The Governance of Not-for-Profit Organizations, ed. E. Glaeser (Chicago: University of Chicago Press, 2003), 181-215.
38. S. Chakravarty et al., "Does the Profit Motive Make Jack Nimble? Ownership Form and the Evolution of the U.S. Hospital Industry," Health Economics 15, no. 4 (2006): 345-361.
39. M.P. Glavin et al., "An Examination of Factors in the Withdrawal of Managed Care Plans from the Medicare+Choice Program," Inquiry 39, no. 4 (2002/03): 341-354;
40. and B.C. Booske, J. Lynch, and G. Riley, "Impact of Managed Care Market Withdrawal on Beneficiaries," Health Care Financing Review 24, no. 1 (2002): 95-115.
41. Devereaux et al., "A Systematic Review."
42. Hillmer et al., "Nursing Home Profit Status."
43. Schlesinger and Gray, "Nonprofit Organizations."
44. A. Davidoff et al., "The Effect of Changing State Health Policy on Hospital Uncompensated Care," Inquiry 37, no. 3 (2000): 253-267.
45. Schlesinger and Gray, "Nonprofit Organizations."
46. Davidoff et al., "The Effect of Changing State Health Policy";
47. J.M. Ferris and E.A. Graddy, "Structural Changes in the Hospital Industry, Charity Care, and the Nonprofit Role in Health Care," Nonprofit and Voluntary Sector Quarterly 28, no. 1 (1999): 18-31;
48. and R.A. Hirth, "Competition between For-Profit and Nonprofit Health Care Providers: Can It Help Achieve Social Goals?" Medical Care Research and Review 54, no. 4 (1997): 414-438.
49. Schlesinger et al., "Profit-Seeking";
50. B.E. Landon et al., "Health Plan Characteristics and Consumers' Assessments of Quality," Health Affairs 20, no. 2 (2001): 274-286;
51. W. Luksetich, M.E. Edwards, and T.M. Carroll, "Organizational Form and Nursing Home Behavior," Nonprofit and Voluntary Sector Quarterly 29, no. 2 (2000): 255-279;
52. C.M. Hughes, K.L. Lapane, and V. Mor, "Influence of Facility Characteristics on Use of Antipsychotic Medications in Nursing Homes," Medical Care 38, no. 12 (2000): 1164-1173;
53. and M. Schlesinger et al., "The Growth of Multi-Facility Health Care Systems and Access to Medical Services," in Advances in Health Services Research, ed. L. Rossiter and G. Wilensky (Greenwich, Conn.: JAI Press, 1986), 121-140.
54. Schlesinger and Gray, "Nonprofit Organizations."
55. Kane and Wubbenhorst, "Alternative Funding Policies";
56. and U.S. Government Accountability Office, Nonprofit Hospitals: Better Standards Needed for Tax Exemption, Pub. no. GAO/HRD-90-84 (Washington: GAO, 1990).
57. M.A. Morrisey, G. Wedig, and M. Hassan, "Do Nonprofit Hospitals Pay Their Way?" Health Affairs 15, no. 4 (1996): 132-144;
58. and GAO, Nonprofit Hospitals.
59. M. Schlesinger, S. Mitchell, and B. Gray, "Measuring Community Benefits Provided by Nonprofit and For-Profit HMOs," Inquiry 40, no. 2 (2003): 114-132.
60. Nonprofits are more likely to provide health promotion services, support safety-net providers, collaborate to meet community needs, conduct community health assessments, and work with local health departments. See G.O. Ginn and C.B. Moseley, "Community Health Orientation, Community-based Quality Improvement, and Health Promotion Services in Hospitals," Journal of Healthcare Management 49, no. 5 (2004): 293-306;
61. Treo Solutions, "Costs, Commitment, and Locality";
62. M. Schlesinger, B.H. Gray, and M. Gusmano, "A Broader Vision for Managed Care, Part 3: The Scope and Determinants of Community Benefits," Health Affairs 23, no. 3 (2004): 210-221;
63. E.J. Proenca, M.D. Rosko, and J.S. Zinn, "Correlates of Hospital Provision of Prevention and Health Promotion Services," Medical Care Research and Review 60, no. 1 (2003): 58-78;
64. G.P. Mays et al., "How Managed Care Plans Contribute to Public Health Practice," Inquiry 37, no. 4 (2001): 389-410;
65. and E.J. Proenca, M.D. Rosko, and J.S. Zinn, "Community Orientation in Hospitals: An Institutional and Resource Dependence Perspective," Health Services Research 35, no. 5, Part 1 (2000): 1011-1035.
66. Kane and Wubbenhorst, "Alternative Funding Policies."
67. M. Schlesinger et al., "A Broader Vision for Managed Care, Part 2: A Typology of Community Benefits," Health Affairs 17, no. 5 (1998): 26-49.
68. E.C. Norton and D.O. Staiger, "How Hospital Ownership Affects Access to Care for the Uninsured," RAND Journal of Economics 25, no. 1 (1994): 171-185;
69. and W. Buczko, "Factors Affecting Charity Care and Bad Debt Charges in Washington Hospitals," Hospital and Health Services Administration 39, no. 2 (1994): 179-191.
70. Malani et al., "Theories of Firm Behavior";
71. and L.R. Mobley and W.D. Bradford, "Behavioral Differences among Hospitals: Is It Ownership, or Location?" Applied Economics 29, no. 9 (1997): 1125-1138.
72. J.P. Clement, K.R. White, and V. Valdmanis, "Charity Care: Do Not-for-Profits Influence For-Profits?" Medical Care Research and Review 59, no. 1 (2002): 59-79;
73. and B.H. Gray, The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals (Cambridge, Mass.: Harvard University Press, 1991).
74. Clement et al., "Charity Care."
75. Silverman and Skinner, "Medicare Upcoding";
76. J.R. Barro and M. Chu, "HMO Penetration, Ownership Status, and the Rise of Hospital Advertising," in The Governance of Not-for-Profit Organizations (Chicago: University of Chicago Press, 2003), 101-116;
77. M. Duggan, "Hospital Market Structure and the Behavior of Not-for-Profit Hospitals," RAND Journal of Economics 33, no. 3 (2002): 433-446;
78. J.R. Horwitz, "Does Ownership Form Matter? Service Provision in the Hospital Industry," NBER Working Paper no. 11376 (Cambridge, Mass. NBER, 2005);
79. R.G. Hughes and H.S. Luft, "Keeping Up with the Joneses: The Influence of Public and Proprietary Neighbours on Voluntary Hospitals," Health Services Management Research 3, no. 3 (1990): 173-181;
80. M. Schlesinger et al., "Competition, Ownership, and Access to Hospital Services: Evidence from Psychiatric Hospitals," Medical Care 35, no. 9 (1997): 974-992;
81. M. Schlesinger et al., "The Privatization of Health Care and Physicians' Perceptions of Access to Hospital Services," Milbank Quarterly 65, no. 1 (1987): 25-58;
82. D. Kessler and M. McClellan, "The Effects of Hospital Ownership on Medical Productivity," NBER Working Paper no. 8537 (Cambridge, Mass.: NBER, 2001);
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84. D.C. Grabowski and R.A. Hirth, "Competitive Spillovers across Non-Profit and For-Profit Nursing Homes," Journal of Health Economics 22, no. 1 (2003): 1-22;
85. P.P. Garg et al., "Effect of Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation," New England Journal of Medicine 341, no. 22 (1999): 1653-1660;
86. and Schlesinger et al., "Profit-Seeking."
87. Kessler and McClellan, "The Effects of Hospital Ownership."
88. Schlesinger et al., "Profit-Seeking."
89. Colombo testimony;
90. D.A. Hyman, "Hospital Conversions: Fact, Fantasy, and Regulatory Follies," Journal of Corporate Law 23, no. 2 (1998): 741-778;
91. F.A. Sloan, "Commercialism in Nonprofit Hospitals," in To Profit or Not to Profit: The Commercial Transformation of the Nonprofit Sector, ed. B. Weisbrod (New York: Cambridge University Press, 1998), 151-168;
92. M.G. Bloche, "Should Government Intervene to Protect Nonprofits?" Health Affairs 17, no. 5 (1998): 7-25;
93. and R.C. Clark, "Does the Nonprofit Form Fit the Hospital Industry?" Harvard Law Review 93, no. 7 (1980): 1416-1489.
94. M. McClellan and D. Staiger, "Comparing Hospital Quality at For-Profit and Not-for-Profit Hospitals," in The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit Institutions, ed. D.M. Cutler (Chicago: University of Chicago Press, 2000), 93-112.
95. S. Heffler et al., "Health Spending Projections through 2013," Health Affairs 23 (2004): w79-w93 (published online 11 February 2004; 10.1377/hlthaff.w4.79).
96. Bloche, "Should Government Intervene?" 14.
97. M. Gusmano and M. Schlesinger, "The Social Roles of Medicare: Assessing Medicare's Collateral Benefits," Journal of Health Politics, Policy and Law 26, no. 1 (2001): 37-79.
98. M.R. Chassin, "Achieving and Sustaining Improved Quality: Lessons from New York State and Cardiac Surgery," Health Affairs 21, no. 4 (2002): 40-51.
99. To contrast ownership-related differences in quality for nursing homes to the mixed effects of regulation, see G.S. Winzelberg, "The Quest for Nursing Home Quality: Learning History's Lessons," Archives of Internal Medicine 163, no. 21 (2003): 2552-2556.
100. D.G. Stevenson, "Is a Public Reporting Approach Appropriate for Nursing Home Care?" Journal of Health Politics, Policy and Law (forthcoming).
101. Bloche, "Should Government Intervene?"
102. E. Brody, "Of Sovereignty and Subsidy: Conceptualizing the Charity Tax Exemption," Journal of Corporate Law 23, no. 4 (1998): 585-629.
103. S. Woolhandler et al., "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance," Journal of the American Medical Association 290, no. 6 (2003): 798-805.
104. R.E. Santerre and J.A. Vernon, "Hospital Ownership Mix Efficiency in the U.S.: An Exploratory Study," NBER Working Paper no. 11192 (Cambridge, Mass.: NBER, 2005).
105. K. Barnett, The Future of Community Benefit Programming (Berkeley, Calif.: Public Health Institute, 1997).