Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Department

Public Administration

Date of Defense

12-1987

Abstract

This study compares nonprofit, government, and forprofit hospitals in South Florida. Property rights arrangement is defined as rights to residual profits in the forprofit hospitals, and the tax-exemption status on the part of nonprofit and government hospitals with obligations to serve charitable purposes in the public interest. This dissertation derives and tests implications about differences in behavior in the context of efficiency, equity, and quality of care delivered in nonprofit, government, and forprofit hospitals.

Fifty-six hospitals with Joint Commission on Accreditation of Hospitals (JCAH) accreditation were compared on institutional variables (bed size, location>; efficiency variables (occupancy rates, ancillary expenses, bad debts, manhours per patient day, salaries per FTE, length of stay/DRG, charges/DRG, reimbursement/ORB (on twenty DRGs); equity variables (Medicare days, Medicaid days, and uncompensated care); and finally, the quality variable (death rates/DRS on twenty DRGs).

The immediate effects of profit maximization is considered as an incentive for managers in the forprofit hospitals. The social obligations attached to the tax-exemption status can be argued as the underlying rationale far output maximization, i. e. maximizing benefits to society by serving more patients in the nonprofit and government hospitals.

Using analysis of variance, nonprofit, government, and forprofit hospitals were compared to determine if statistically significant differences were present at the .05 level of significance. Pairs of hospital types were tested for significant differences using ANOVA, Mann-Whitney, and multiple regression analysis.

The results provided mixed support for the property rights theory. Significant differences were found on institutional variables, bed size and location; efficiency variables, bad debts, manhours per patient day, and charges per DRG; equity variables Medicare days, Medicaid days, and uncompensated care. In terms of the quality variable, the death rates per DRG showed no statistical significance.

Unexpectedly, nonprofit hospitals were very similar to forprofit hospitals on the variables bad debts and Medicaid days. The relevance of this finding to health policy issues today, particularly tax-exemption privileges, warrant a suggestion for further evaluation of the performance of the nonprofit sector.

Identifier

FI14032312

Comments

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