美国医院的类型

在美国有三种医院,即私人营利性医院(占总数12%)、国家医院(占38%)、私人“非营利性”医院(占50%)。私人营利性医院的资本是建立在个人、集体和股份合资基础上的,它们的主要服务对象是那些对各种辅助设施和高质量的护理,具有支付能力的患者。收治的病人多是病情不复杂,治疗上     

对营利性与非营利性医院分类管理的思考

医疗机构分为营利性与非营利性两类 ,那么两类医院各占市场多少比重 ,如何管理才能取得其最佳运行是需要探讨和研究的。一、我国医院营利性与非营利性医院的分类现状长期以来 ,非营利性医院主体是国立医院、集体医院 ,无论在城市农村都为社会提供着９５%以上的社会医疗服务量 ,由政府制定统一的收费标准 ,资金来源主要是靠政府补贴和低收费。医疗卫生事业这种福利性质与卫生计划经济体制和国家计划经济体制基本相适应。随着我国市场经济体制的建立 ,促使医疗卫生机构不断调整经营机制 ,以适应市场经济体制 ,对营利性医院与非营利性医院分类…     

美国非营利性和营利性医院的比较分析

从所有权角度看,美国医院分为政府举办的非联邦医院（Government,nonfederal）、政府举办的联邦医院（Government,federal）、私立非营利性医院（Private not-for-profit）和私立营利性医院（Investor-owned）.政府举办的联邦医院主要服务于现役军人、退伍老兵和印第安人等特殊群体,并且实行不同的管理和财政补偿政策,一般的研究都将其排除在研究对象之外.因此,非营利性医院包括政府举办的非联邦医院和私立非营利性医院,营利性医院主要是私立营利性医院.据统计,2004年美国4927所非联邦医院中约有60%属于非营利性医院.本研究将利用1998、2000和2002年的数据对两类医院不包括专科医院）的特征进行比较,并为我国医院分类管理的研究和政策制定提出建议.     

营利性医院和非营利性医院的现行管理体制差异

医疗机构分类管理是一个必然的趋势。按照医院的经营目的不同 ,医院可分为营利性医院和非营利性医院两类。现行体制之下非营利性医院主要解决的是公平性问题。面对WTO的挑战 ,当务之急是明确产权主体 ,建立现代医院管理制度 ,加强医院管理 ,完善非营利性医院的运行机制。改革是非营利性医院生存和发展唯一的出路。营利性医院的出路在于完善的配套政策和公平的竞争环境 ,对其地位和作用做出正确评估。     

非营利性医院的经济学特点及其利润再分配特色初探

世界上许多国家都把医院区分为营利性和非营利性 ,我国也即将采用这种区分方法 ,营利性和非营利性医院的主要区别不在于它们是否盈利 ,而在于所获取的利润如何分配。对于这个问题 ,不同的国家有不同的做法。在中国 ,这是一个全新的问题。本文试图作一些有益的探讨。一、非营利性医院的经济学特点非营利性医院是在我国现有的公有制医院的基础上改造而来的 ,但它绝不是原有医院简单的翻版 ,具有鲜明的经济学特点。１．非营利性医院是政府办的公益性事业单位在我国 ,非营利性医院在医疗体系中占主导地位 ,肩负着为全体人民群众提供医疗保健等卫…     

非营利性医院能否变为营利性

正非营利性医院是指医院运营中的收入除规定的合理支出外,只能用于医院的继续发展,不能用于分红。而营利性医院则可以自主定价、医院股东可以就医院收益获得分红以及可以上市融资。非营利性医院变更为营利性医院有利于补充医院市场的竞争要素,减少竞争不足的现象,通过充分竞争,向市场提供更为优质的医疗服务。同时,非营利性医院变更为营利性医院也符合     

美国医疗机构分类管理的启示

为适应卫生改革形势 ,学习和借鉴美国医疗机构实行营利性和非营利性分类管理的经验和方法 ,笔者赴美考察了营利性的乔治华盛顿大学医院、非营利性的华盛顿医疗中心(WashingtonHospitalCenter)和蒙哥马利郡的一所社区医院(Shady GroveAdventistHospital) ,分别就两类医院组织结构与运作特色、资金来源与管理、税收政策等进行咨询了解 ,现将有关情况介绍如下。一、基本状况在美国 ,医院的主体是私立医院 ,约占70 %。但在私立医院中 ,并不是营利性医院占多数 ,而是非营利性医院占多数。非营利医院指社区医院、教会医院、自愿捐助者医院或其…     

非营利性医院的界定及政策选择

《关于城镇医药卫生体制改革的指导意见》(以下简称《指导意见》)提出,今后我国医疗机构将分为营利性与非营利性两类进行管理,不同性质的医疗机构实行不同的政策。长期以来,我国医疗机构基本上都依照非营利性医院的规则进行管理,实行分类管理后,一部分医疗机构将定位于营利性医院,那么非营利性医院如何界定?非营利性与营利性医院在政策上有哪些区别?这些都引起各方的关注,急切要求在理论和实践上作出回答。一、非营利性医院的界定社会组织根据其经济性质、经营目标,分为营利性及非营利性两类,非营利性组织是指不以谋取利润为目的,而以履行…     

我国医疗机构现状

1　医疗机构数全国共有各级各类医疗机构2 9.7万个(不含村卫生室,下同)。其中非营利性医疗机构14 .2万个,营利性15 .2万个,尚未划分的医疗机构占1%。2 9.7万个医疗机构中,国有全资占32 % ,集体全资占18% ,私营占4 6 % ,(绝大部分为私营诊所) ;联营、股份合作、港澳台投资、中外合资等类型占4 %。2　床位和大型设备数全国医疗机构实有床位311.3万张,其中,非营利性医疗机构占94 .9% ,营利性机构仅占2 .7%。县及县以上医院万元以上医用设备平均每院4 6台。非营利性医院万元以上设备拥有量是营利性医院的4倍。港澳台投资医院万元以上设备平均拥…     

美国医院的财务管理

美国的医院分为营利性和非营利性两大类 ,主要包括公立医院、私立医院和教会医院。公立医院由政府举办 ,属非营利性 ;私立医院由私人、公司、保险公司等兴建和经营 ,属营利性 ;教会医院则由宗教组织出资并经营 ,多数属非营利性。非营利性医院除药品差价收入外不纳税 ,营利性则需交税。一、美国医院的财务管理体制美国私立医院一般实行集团 (公司 )管理 ,集团 (公司 )下辖数家至上百家医院 (医疗中心 ) ,分布在某一地区或全国各地。在财务上集团实行集中管理的模式 ,各医院的财务由集团的财务结算中心或区域财务结算中心负责管理和核算 ,一切…     

Organizational rationality,performance, and social responsibility: results from the hospital industry

Drawing on stakeholder theory and Weber's distinction between formal and substantive rationality, we posit that: (1) for-profit organizations manage stakeholders in ways that result in the organization being more efficient and less socially responsible than organizations that are not as profit oriented, and (2) organizations with major corporate relationships that are not local manage stakeholders in a manner that results in the organization being more efficient and less socially responsible than organizations without such arrangements. We test these hypotheses with 1994 data on 4,705 of the nation's short-term general hospitals using two measures of hospital efficiency and four measures of social responsibility. Results confirm that for-profit hospitals and hospitals lacking local ties are managing stakeholder relationships in ways that increases the efficiency of these hospitals but decreases their social responsiveness. We conclude by speculating that organizational efficiency and social responsibility may be inversely related and then summarize some of the academic, managerial, and policy implications, with emphasis on the implications for stakeholder theory.     

'Profit' variability in for-profit and not-for-profit hospitals

This paper proposes two tests of the hypothesis that not-for-profit hospitals (NFPs) behave differently than for-profit hospitals. The profit variability test states that the profits of an NFP will be less variable over time than profits of a for-profit hospital if the NFP maximizes utility subject to a profit constraint. The second test examines whether NFP profits respond less to change in exogenous factors, such as Medicare reimbursement rates, than profits of for-profit hospitals. Both tests, performed on panel data from 1983 to 1988, support the hypothesis that NFPs behave differently than for-profit hospitals.     

A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals

Not-for-profit (NFP) and for-profit (FP) hospitals were compared on several performance indicators including revenues, costs, productivity/efficiency, and profitability. The indicators were adjusted, where appropriate, for outpatient activity and a case-mix index for all patients. FP hospitals had higher profit margins as well as higher gross and net revenues per case-mix adjusted admission. On the other hand, NFP hospitals had lower total cost per case-mix adjusted admission even after subtracting taxes from FP hospital costs. There were no significant differences between the two groups on efficiency and productivity indicators--paid hours per case-mix adjusted admissions, occupancy levels, and case-mix adjusted ALOS. The higher profits of FP hospitals were attributed to revenue management rather than cost and efficiency management.     

The economics of for-profit and not-for-profit hospitals

This paper examines the economics of for-profit and not-for-profit hospitals through the prism of capital acquisitions. The exercise suggests that of two hospitals that are equally efficient in producing health care, the for-profit hospital would have to charge higher prices than the not-for-profit hospital would, to break even on capital acquisitions. The reasons for this divergence are (1) the typically higher cost of equity capital that for-profit hospitals face; and (2) the income taxes they must pay. The paper recommends holding tax-exempt hospitals more formally accountable for the social obligation they shoulder, in return for their tax preference.     

Profits in medicine: a context and an accounting.

The U.S. health care industry is composed of a dynamic mixture of profit and non-profit entities. These sectors sometimes compete in the same activities and may have virtual monopolies over other activities. Estimates of the relative and absolute sizes and growth trends of the profit and non-profit sectors are developed in this article. These estimates show that approximately 39 percent of total health care expenditures in the U.S. in 1975 went to for-profit institutions, generating $3.3 billion in profit. This represented 7 percent of for-profit and 2.8 percent of total expenditures. Some for-profit subsectors grew more rapidly and others less rapidly than total health care expenditures. As a whole, the for-profit sector grew faster than the non-profit sector before and after Medicare and Medicaid were introduced as well as during the period when price controls were in effect. The relative growth of the for-profit sector was greatest right after the introduction of Medicare and Medicaid. The true significance of profit lies not in numbers, but in the effects that the drive for profit have on the nature and quality of health and health care. This is discussed in the final section.     

Profit efficiency and ownership of German hospitals

This paper investigates the cost and profit efficiency of German hospitals and their variation with ownership type. It is motivated by the empirical finding that private (for-profit) hospitals - having been shown to be less cost efficient in the past - on average earn higher profits than public hospitals. We conduct a Stochastic Frontier Analysis on a multifaceted administrative German data set combined with the balance sheets of 541 hospitals of the years 2002-2006. The results show no significant differences in cost efficiency but higher profit efficiency of private than of publicly owned hospitals.     

A comparative analysis of the community contributions and profits of Virginia's hospitals

BACKGROUND: In return for receiving favorable treatment from the government, U.S. general hospitals are expected to provide contributions to their community consisting of charity care, bad debt, and taxes paid. Recently, the Government Accountability Office proposed that an analysis that compares what for-profit and nonprofit hospitals contribute be conducted. PURPOSE: For 72 Virginia hospitals, it is determined whether (a) for-profit hospitals' community contributions exceed their profits and (b) nonprofit hospitals' community contributions exceed the for-profits' contributions in addition to the nonprofits' forgone taxes. METHODOLOGY/APPROACH: Based on audited fiscal year 2004 financial statements, six null hypotheses were tested for significant differences between the two independent variables, namely, hospital charter and size, and the three dependent variables, including (a) operating income, (b) the ratio of community contributions to net patient revenues, and (c) the ratio of community contributions to operating income. FINDINGS: No significant differences were found to exist between (a) hospital charter and operating income, (b) hospital charter and the percentage of community contributions to net patient revenues, and (c) hospital charter and the percentage of community contributions to operating income. The community contributions of nonprofits exceeded their taxes forgone by a wide margin, but they fell short of exceeding the for-profits' community contributions plus the taxes forgone by a very slight margin. PRACTICE IMPLICATIONS: Hospital management, in conjunction with health care policy planners, needs to develop mutually acceptable standards regarding the required level of hospitals' community contributions. It is proposed that the most equitable standard is "quartile comparisons" for a given hospital's financial performance and its level of community contributions. Furthermore, to reduce charity care, it is imperative that high-cost hospital treatment of primary health care for indigent patients be shifted to lower cost delivery systems.     

The effect of managed care on hospital marketing orientation

Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short-term gains by capturing managed care business, but may not be sufficient for long-term success and survival. Understanding consumer needs and perceptions, and using appropriate marketing strategies to ensure greater customer satisfaction and repeat business, will be among the key tasks for hospital executives in the future.     

A matter of value. Profits and losses in healthcare

In the growing debate over for profit enterprise in healthcare, the real issues are ownership, conflicts of interest, profit margins, and what is done with those profits--not tax status or the presence or lack of a profit. Every healthcare sector--except hospitals--is now dominated by proprietary enterprise, and current attention is focusing on three types of entities: megasystems, systems and group practices, and for-profit HMOs. The question is, Do we indeed have a problem with the profit-related issues I have mentioned? A great deal of fog surrounds the discussion. Both the public and many healthcare people feel discomfort with the idea that healthcare is a commercial commodity. But there seems to be a certain amount of hypocrisy in how the argument has been framed; only certain for-profits are characterized as posing a threat. What we are really dealing with is a massive shift of power from one interest to another. Some not-for-profit providers' loss of money and power, however, does not mean that for-profits that gain money and power are scurrilous. Thus the debate over proprietary enterprise has been colored by extraneous concerns and hidden agendas. Nonetheless, three serious issues merit closer inspection: 1. Is the for-profit model flawed? Indeed, moral hazards certainly seem to be involved in stock holder-held entities that provide direct services to patients. 2. Is the problem making a profit or profiteering? Even if nonprofits are sometimes profiteers, the for-profits are hardly innocent. In addition to the huge sums being provided to stockholders, executives of proprietary firms often do very well indeed. 3. Do new models such as systems and HMOs pose any special problems when they are proprietary? In terms of systems, the jury is still out. Despite evidence that proprietary systems are forcing everyone to be more efficient, the question remains of who will subsidize unprofitable services like burn units and true indigent care if the system's hospitals and clinics do not provide it. When it comes to managed care, the tempting incentives to constrain access and skimp on services, combined with the requirements of for-profit enterprise, simply produce too dangerous a situation.     

Profit and Non-Profit Home Health Care Agency Outcomes

The home health care industry, traditionally an industry of non-profit organizations, has increasingly become, as has the rest of the health care industry, invaded by for-profit organizations. The impetus for this invasion was the Omnibus Reconciliation Act (OBRA) of 1980 which encouraged previously restricted for-profit organizations to participate in the Medicare and Medicaid home health care program. Following enactment of OBRA, the number of for-profit organizations grew rapidly and the advantages and disadvantages of their presence in the market has been widely debated. The purpose of this study was to describe differences in behaviors and industry outcomes generated by non-profit and for-profit organizations in Massachusetts. Data for the study was from the Massachusetts State Department of Public Hcalth's Annual Reports of Home Health Agencies. Results suggest that while profit and non-profit agencies behave similarly in many areas, there are areas of difference, with significant differences found in the amount of service delivered and the rates charged.