Competition between non-profit and for-profit health insurers

This study investigates the effects of tax, regulatory, and reimbursement policies and other factors exogenous to the health insurance market on the relative price (to commercial insurers) paid by Blue Cross plans for hospital care, their administrative expense and accounting profits, premiums, and ultimately Blue Cross market share. We specify and estimate a simultaneous equation model to assess interrelationships among these variables. We conclude that premium tax advantages enjoyed by the Blues have virtually no effect on the Blues' premiums or their market shares. A Blue Cross plans' market share has a positive effect on the discount it obtains from hospitals as does coverage of Blue Shield charges by a state-mandated rate-setting plan. An upper bound on the effect on the Blue Cross market share of covering Blue Cross under rate-setting but excluding the commercials from such coverage is seven percentage points. Tests for administrative slack in the operation of Blue Cross plans yield mixed results.     

Consumer information and competition between nonprofit and for-profit nursing homes.

This paper develops implications of Arrow's hypothesis that nonprofit organizations are prevalent in health care because of quality uncertainty. The model analyzes the ability of nonprofits to mitigate market failures created by asymmetric information in an environment characterized by potential competition from both explicitly for-profit firms and for-profits in disguise (profit-motivated firms who obtain nonprofit status in order to exploit the perceived trustworthiness of the nonprofit sector). Under certain conditions, it is shown that nonprofit status can serve as a credible signal of quality and that nonprofits can decrease the underprovision of quality both by providing high quality services and indirectly via a spillover effect on quality in the for-profit sector. Applicability to long-term care and implications for empirical research and policy towards nonprofits in health care are discussed.     

Differences between non-profit and for-profit hospices: patient selection and quality

This research compares the behavior of non-profit organizations and private for-profit firms in the hospice industry, where there are financial incentives created by the Medicare benefit. Medicare reimburses hospices on a fixed per diem basis, regardless of patient diagnosis. Because under this system patients with lower expected costs are more profitable, hospices can selectively enroll patients with longer lengths of stay. While it is illegal for hospices to reject potential patients explicitly, they can influence their patient mix through referral networks. A fixed per diem rate also creates an incentive shirk on quality and to substitute lower skilled for higher skilled labor, which has implications for quality of care. By using within-market variation in hospice characteristics, the empirical evidence suggests that for-profit hospices differentially take advantage of these incentives. The results show that for-profit hospices engage in patient selection through significantly different referral networks than non-profits. They receive more patients from long-term care facilities and fewer patients through more traditional paths, such as physician referrals. This mechanism of patient selection is supported by the result that for-profits have fewer cancer patients and more patients with longer lengths of stay. While non-profit and for-profit hospices report similar numbers of staff visits per patient, for-profit firms make significantly less use of skilled nursing providers. We also find some weak evidence of lower levels of quality in for-profit hospices.     

An examination of childcare teachers in for-profit and non-profit childcare centers

Perceptions of childcare teachers in for-profit and non-profit centers were examined. Previous research indicates that childcare teachers earn consistently low wages, have little employee benefits and are dissatisfied with their work environments. This study further explores the employment issues and work environments that childcare teachers encounter. Questionnaires were distributed throughout a southeast state in the United States to 558 childcare teachers from for-profit and non-profit centers. Although there were significant differences with regard to age, hourly income and number of hours worked, overall it appears as though for-profit and non-profit childcare teachers represent a rather homogeneous population with regard to the working environments and employee issues.     

Do non-profit nursing homes separate governance roles?: The impact of size and ownership characteristics

Separation between operational responsibilities and those of oversight is an important point of discussion in governance. Novel to the literature, this paper not only offers direct evidence on the degree of separation, but also shows its relationship with size (ceteris paribus efficiency prescribes that large organizations implement more separation) and ownership characteristics of non-profit institutions. Using a sample of Belgian (Flemish) nursing homes, we find that in private nursing homes this separation increases with size while this is not the case in public homes. We document that this lack in flexibility in governance practices explains the micro-monitoring in public institutions. We formulate policy implications and suggest solutions to create more flexibility and likely also better governance.     

Legitimacy, trustee incentives, and board processes: the case of public and private non-profit nursing homes

Using a unique data set, this study explores how type of ownership (government/private) is related to processes of governance. The findings suggest that the neo-institutional perspective and the self-interest rationale of the agency perspective are helpful in explaining processes of governance in both government- and privately owned non-profit organizations. Due to adverse incentives and the quest for legitimacy, supervising governance bodies within local government-owned non-profit institutions pay relatively less attention to the development of high quality supervising bodies and delegate little to management. Our findings also indicate that governance processes in private institutions are more aligned with the business model and that this alignment is likely driven by a concern to improve decision making. By contrast, our data also suggest that in local government-owned institutions re-election concerns of politicians-trustees are an important force in the governance processes of these institutions. In view of these adverse incentives - in contrast to the case of private organizations - a governance code is unlikely to entail much improvement in government-owned organizations.     

美国非营利和营利医院的定价策略

主要介绍了美国非营利性营利性医院的定价策略，并用经济学模型定性模拟了非竞争和竞争环境下各类医院的价格制定。     

Comparative analysis of the non-profit, for-profit and public hospital providers: American experiences

BACKGROUND AND OBJECTIVES: The new legislation allowed hospitals and other health care facilities to be converted into for-profit status. The detailed regulatory framework is under development in Hungary. This article reviews the literature of studies comparing hospital financial performance and the quality of care before and after conversion from public or non-profit status to for-profit. METHODS: Studies were identified through electronic search of Medline (Pubmed), EconLit, Cochrane Library, Economic Evaluation Database (EED), az Health Technology Assessment (HTA) databases, library files and reference lists. The literature search was extended to the Internet, World Bank, International Labor Office (ILO), Organization for Economic Cooperation and Development (OECD), and WHO websites as well as government, academic institutions and large insurance companies web pages for unpublished online information. Time series and before-after studies and systematic literature reviews were included. RESULTS: The conversion from non-profit to for-profit status improved the profitability of the hospitals. However the quality of care (measures in mortality, frequency of side effects, complications) might suffer in the first couple years of the conversion. The conversion may increase the total health care expenditures per capita. Trustful relationship between patients and physicians may also be threatened. CONCLUSION: The generalisability of the American experiences into the Hungarian single payer system may be limited. From societal point of view, for-profit providers could provide socially beneficial care in areas where it is possible to define, monitor and evaluate the nature and quality characteristics of the services, as well as market competition can be ensured. However most of the healthcare services are too complex to fall into this category.     

Childcare center directors' perceptions of their work environments: a comparison of for-profit and non-profit programs

Perceptions of childcare center directors in for-profit and non-profit childcare centers were examined. Previous research indicates that childcare employees are poorly compensated, not properly trained, and dissatisfied with their work environment. This study explores further into the training, work environment, and job satisfactions of childcare center directors. Questionnaires were distributed throughout a southeast state in the United States to three hundred and ten childcare center directors from for-profit and non-profit centers. Levels of job satisfaction, work environments (including employment benefits and challenges), and the educational and training experiences of for-profit and non-profit childcare center directors were examined. There were no significant differences between for-profit and non-profit center directors in their perceptions of job satisfaction and in their reports of benefits and challenges. However, there was a significant difference in education level of directors with directors of non-profit centers having higher educational attainment than directors of for-profit centers.     

The valuation of pastoral care by hospital administrators: a survey of selected for-profit and non-profit institutions

This paper reports on a study of 600 hospital administrators, half of which were in non-profit institutions and half of which were in hospitals owned or managed by the Hospital Corporation of America. The project was designed to identify what differences, if any, existed between surveyed administrators in both types of institutions in their valuation of pastoral care. No significant differences were found between the two groups of administrators in the valuation of pastoral care. All administrators were found to be concerned about the quality of patient care and to value aspects of care such as pastoral care which are personal and difficult to quantify.     

Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes

We describe the racial segregation in U.S. nursing homes and its relationship to racial disparities in the quality of care. Nursing homes remain relatively segregated, roughly mirroring the residential segregation within metropolitan areas. As a result, blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability. Changing health care providers' behavior will not be sufficient to eliminate disparities in medical treatment in nursing homes. Persistent segregation among homes poses a substantial barrier to progress.