Sample Health Care Organizations Research Paper. Browse other research paper examples and check the list of research paper topics for more inspiration. If you need a research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our custom research paper writing service for professional assistance. We offer high-quality assignments for reasonable rates.
This research paper must begin with an explanation of the meaning and boundaries of its subject. First, its focus is on organizations, not on the motivation of individuals. Second, it pertains to two ownership categories that by convention, partly rooted in the US experience, stand in distinction to public or governmental ownership. That is, this research paper pertains to nongovernmental organizations, which may be established as for-proﬁts or as nonproﬁts.
Academic Writing, Editing, Proofreading, And Problem Solving Services
Get 10% OFF with FALL23 discount code
Third, it pertains to a legal characteristic of organizations that is deﬁned under the law of the jurisdiction in which they exist. In the USA, health care organizations are typically incorporated under state laws. Variations among these state laws are not important for our purposes, but the fact that fundamental aspects of the ownership and control of health care organizations (as well as the roles they play in the health care system) are deﬁned by the laws and traditions that are speciﬁc to particular countries is. A recent eﬀort to measure and compare the size of the nonproﬁt sectors in diﬀerent countries had to deﬁne ‘nonproﬁts’ in terms of certain organizational characteristics (not proﬁt-distributing, self-governing, voluntary) rather than legal form, because nations do not make the same legal distinctions between private and governmental or between for-proﬁt and nonproﬁt (Salamon et al. 1999). To cite an example from health care, ownership by identiﬁable individuals is incompatible with the nonproﬁt form under US law, while Japan, where most hospitals are owned by physicians, is often said to prohibit for-proﬁt ownership of hospitals because of a prohibition of ownership by corporations that pay dividends (Rodwin and Okamoto 2000).
Fourth, this research paper pertains primarily to types of health care organizations in which a mix of for-proﬁt and nonproﬁt ownership is found. Thus, attention will not be directed to organizations that manufacture pharmaceuticals or hospital supplies (which are typically all for-proﬁt corporations), to physicians’ practices (which are seldom incorporated as nonproﬁt organizations), or to charitable fundraising organizations (such as the American Cancer Society or the Royal Commonwealth Society for the Blind), which are all nonproﬁt. Our focus is on the types of organizations among which both for-proﬁts and nonproﬁts can be found, as is the case with hospitals, nursing homes, health maintenance organizations, and home care agencies in the USA.
Most literature on for-proﬁt and nonproﬁt health care comes from the USA, which has an unusually pluralistic health care system on both the provider and purchaser sides (Starr 1982). Although the health care systems of other countries are much more typiﬁed by governmental or quasigovernmental ownership, the private ownership of important components, such as hospitals, is not peculiar to the USA. In some countries there are doctor-owned clinics, small hospitals, or nursing facilities that are outgrowths or extensions of private physicians’ oﬃces. Some countries that have universal health insurance systems nonetheless have private hospitals. These countries may either prohibit for-proﬁt ownership, as does Canada, or they may exclude private hospitals (including for-proﬁts) from participation in the national health insurance system, while permitting for-proﬁt hospitals to serve people who have the desire and wealth to opt out of that system. Several investor-owned hospital companies from the USA also own hospitals in other countries, serving such niches. And at least one German hospital company owns some US hospitals. In recent years, American companies have begun to export versions of managed care to other countries, notably in Latin America (Stocker et al. 1999).
In the main, however, in Western countries other than the USA for-proﬁt organizations that provide health services are extensions of doctors’ practices or constitute a sector that serves a small market outside of the governmental health system (and is often not included in statistical information about that system). This, plus the nation-speciﬁc nature of the laws that deﬁne the legal form of health care organizations, probably explains the paucity of research comparing for-proﬁt nonproﬁt organizations in countries other than the USA or making cross-national comparisons of ownership forms. Policy debates about privatization have stimulated research on public versus private provision of services in a number of countries, but these are outside the scope of this research paper.
1. The Nonproﬁt For-Proﬁt Distinction
In this research paper, the terms ‘for-proﬁt’ and ‘nonproﬁt’ (or its less economical synonym, ‘not-for-proﬁt’) are used as they are commonly deﬁned under state statutes and federal tax law in the USA. The term ‘nonproﬁt’ invites confusion, since nonproﬁt organizations are not forbidden from generating surpluses of revenues over expenses. Indeed, such surpluses, which are called proﬁts in the for-proﬁt world, are essential to economic health and survival of nonproﬁt organizations. It is important, therefore, to be clear about the shared characteristics of for-proﬁt and nonproﬁt organizations and the ways that they diﬀer.
Table 1 shows that there are important similarities and diﬀerences between for-proﬁt and nonproﬁt health care organizations in the USA (Gray 1992). Two key families of legally deﬁned characteristics are particularly important in distinguishing these organizations. The ﬁrst pertains to ownership, governance, and purpose. For-proﬁt organizations have owners (proprietors, partners, or the shareholders of corporations), who share in the proﬁts and increases (or decreases) in the value of the enterprise and who, in the corporate form, elect the board of directors. Those who operate the for-proﬁt organization are thus either owners or are managers who are directly accountable to owners. Thus, those who control the organization have a direct stake in the ﬁnancial performance of the organization.
By contrast, nonproﬁt organizations do not have owners (except insofar as they are subsidiaries of other nonproﬁt organizations) and are legally prohibited from distributing surplus revenues to those who control the organization—a characteristic that Hansmann (1980) called the nondistribution constraint. Nonproﬁt organizations are governed by boards of trustees whose members are typically chosen by the existing board and who are responsible for assuring that the organization operates soundly and adheres to the mission (charitable, educational, religious, etc.) for which it was chartered. Importantly, the boards to which management is accountable have no direct stake in the proﬁtability of the institution.
The second family of diﬀerences pertains to the tax treatment of for-proﬁt and nonproﬁt organizations (Simon 1987). Nonproﬁt organizations that meet qualifying standards have a variety of tax-related beneﬁts under federal, state, and local laws. The tax treatment of nonproﬁts varies according to the kind of organization it is (for example, there are diﬀerences in how churches, grant making foundations, charitable organizations, and professional associations are treated) and according to governmental jurisdiction (criteria for exemption from local property taxes may diﬀer from criteria for exemption from federal corporate income tax). However, most nonproﬁt health care organizations are exempt as charities from federal corporate income tax under Section 501(c)(3) of the Internal Revenue Service Code. Charity in this case is deﬁned in terms of beneﬁting the community at large, not in terms of providing free care (Fox and Schaﬀer 1991). (Some health maintenance organizations and insurers are exempt under Section 501(c) (4) as social welfare organizations and receive less-favorable tax treatment than do the charitable organizations.) Other tax beneﬁts also apply to organizations that are exempt in the eyes of the Internal Revenue Service. Charitable nonproﬁts are generally able to receive contributions that are tax deductible to the donor, to borrow at favorable rates under bond issues whose interest is not taxable to the lender, and to be exempt from local and state property taxes and certain excise taxes.
However, in health care there are important ﬁnancial similarities between for-proﬁts and nonproﬁts. First, the revenues of both for-proﬁt and nonproﬁt health care organizations come overwhelmingly from the sale of services. For most nonproﬁt health care organizations, charitable contributions represent no more than one percent of revenues. To survive, these nonproﬁt organizations must compete successfully for business in a very crowded and heavily regulated marketplace. Though not businesses, they must operate in a very businesslike fashion.
Second, although nonproﬁt hospitals and HMOs have beneﬁted in earlier periods from governmental grant and lending programs, today’s nonproﬁts and for-proﬁts depend upon similar sources of capital— primarily retained earnings and debt (Institute of Medicine 1986). Thus, just as with for-proﬁt organizations, the primary capital sources on which nonproﬁt health care organizations depend are a function of the organization’s economic performance. The fact that the typical nonproﬁt health care organization is tax exempt as a charitable organization under the Internal Revenue Service code suggests that they are subject to complex and somewhat conﬂicting social expectations.
Notwithstanding the importance of their common reliance on retained earnings and debt, for-proﬁt and nonproﬁt organizations each have access to unique sources of capital. Unlike nonproﬁts, for-proﬁts have the paid-in equity capital of individual and organizational investors or stockholders. Access to equity capital provides a substantial advantage during periods of growth, particularly for publicly traded ﬁrms whose stock price in relationship to earnings may be very high. The unique form of capital to which nonproﬁts have access is charitable contributions, as well as debt ﬁnancing from instruments whose interest payments are not taxable for the lender.
These diﬀerences in sources of capital are enormously important regarding the expectations placed on these organizations—with stockholders seeking value, economic returns, and capital growth, and contributors seeking charitable behavior. The two families of diﬀerences have driven theoretical and empirical work in the social sciences (Powell 1987, Powell and Clemens 1998) and stimulated an array of public policy debates.
2. The Role And Performance Of Nonproﬁt Organizations
The question of why some segments of our capitalist economy are predominantly for-proﬁt while others are predominantly nonproﬁt has intrigued social theorists and economists, who generally start with the premise that the incentives internal to the for-proﬁt structure create a drive toward eﬃciency. So, what is the role of nonproﬁts? Several answers have been oﬀered. Weisbrod (1990) suggests that nonproﬁts occupy a niche created by, on the one hand, the failure of for-proﬁt organizations to provide services that beneﬁt the community at large, not just the purchasers, and, on the other hand, the failure of governmental programs to meet the demand for other than average services. Hansmann (1980) posits that the nonproﬁt form provides a comparatively eﬃcient alternative in situations of contract failure in which purchasers are not well situated to monitor the performance of sellers of services. The nondistribution constraint makes nonproﬁts less likely than for-proﬁts to exploit the purchaser’s vulnerability. For services to be ﬁnanced by donations, the nonproﬁt form gives potential donors some conﬁdence that their funds will be used for the promised purpose (e.g., for charitable services). For services that are diﬃcult for purchasers to monitor (and medical care is an example), the nonproﬁt form may provide some assurance that vulnerabilities of patients and payers will not be exploited.
Such theories suggest three directions in assessing the performance of nonproﬁt organizations—their costliness (in the absence of accountability to owners, are they less eﬃcient?), their charitability (very important for tax-exempt organizations in a health care system with more than 40 million uninsured patients), and their eﬀectiveness or trustworthiness as providers of services/care. The empirical literature that has attempted to assess these topics in diﬀerent types of health care organization is large, growing, and impossible to summarize adequately in a brief article. Citations to most studies can be found, however, in the Institute of Medicine (1986) report on for-proﬁt and a 1999 literature review that is available on-line (Gray et al. 1999) and that summarizes some 75 studies.
First, in health care, for-proﬁt organizations are not necessarily less costly to purchasers than are nonproﬁts. Most studies of hospitals have found that costs to purchasers are higher in for-proﬁts (Gray et al. 1999). This appears to be a response to ‘reimbursement maximization’ strategies based on exploiting the weaknesses of third-party payment systems, not to some inherent ineﬃciency disadvantage of for-proﬁts vis-a-vis nonproﬁts. For example, several studies have shown that expenses incurred in the production of hospital services are similar in for-proﬁt and nonproﬁt hospitals, but that markups of price over expenses are higher in for-proﬁts.
Second, taken as a group, nonproﬁts are more likely to engage in charitable activities and public goods than are for-proﬁts (Gray 1992, Claxton et al. 1997, Gray et al. 1999). For example, nonproﬁts care for more uninsured patients (Frank et al. 1990), provide more uncompensated care (Lewin et al. 1988), provide more services focused on vulnerable populations (LeBlanc and Hurley 1995, Shortell et al. 1987), and engage in education and research (Institute of Medicine 1986), and they are less likely to discourage admission of uninsured patients (Schlesinger et al. 1987) and less likely to avoid location in areas with large numbers of the uninsured (Norton and Staiger 1994). However, the charitable performance of nonproﬁts is quite variable, with charitable activities and public goods heavily concentrated in urban teaching hospitals. The performance of nonproﬁt hospitals as charitable organizations has come under criticism in recent decades, and in the 1990s eight US states established requirements for nonproﬁt hospitals to report on their community beneﬁt activities. There is evidence that the charitable performance of nonproﬁts is enhanced by articulated community expectations and active public oversight (Schlesinger 1998).
Third, although the Institute of Medicine (1986) study found no clear pattern of ownership-related quality diﬀerences among hospitals, several more recent studies have found a quality advantage for nonproﬁts regarding hospital mortality (Hartz 1989, Kuhn et al. 1994, Sloan et al. 2000) and post-hospital recovery (Sloan et al. 2000). Quality advantages have been reported among nonproﬁt nursing homes (Hawes and Phillips 1986) and HMOs (Himmelstein et al 1999), two ﬁelds characterized by serious contractfailure problems. In nursing homes, many residents are unable to look after their own best interests and have no one else to do so and so must rely on their notoriously diﬃcult-to-monitor relationship with the facility to protect their interests. In HMOs, the complexity of the incentive relationship between health plans and physicians may make it diﬃcult for patients to be certain that contracted-for services are actually being provided.
At a more general level, the research ﬁndings to date suggest that for-proﬁts are indeed more responsive to economic incentives than are nonproﬁts, which can be a problem in a ﬁeld with signiﬁcant information asymmetries between sellers and purchasers of service (Arrow 1963). In view of the similarities of for-proﬁts and nonproﬁts in revenue capital and revenue sources and the regulatory regimes under which they must operate, the overall pattern of performance diﬀerences that are often small but generally in the predicted direction is notable. It is clear that the comparative performance of nonproﬁts and for-proﬁts is not a simple function of ownership form, but of an interaction of ownership form with market forces, payment systems, and regulatory environments.
3. Ownership Trends In Health Care
The concentration of diﬀerent forms of ownership varies in the USA across ﬁelds (nursing homes are predominantly for-proﬁt; hospitals are mostly nonproﬁt) and over time (Marmor et al. 1987, Gray 1999). Among acute care community hospitals, surveys conducted early in the twentieth century reported that about half of all hospitals were for-proﬁt (Stevens 1989, Starr 1982). The for-proﬁt share of hospitals declined through the century, falling to 15 percent in 1965, with nonproﬁts comprising 60 percent and the remainder governmental—a level that has remained roughly the same, with a slight increase in for-proﬁt and a slight decrease in governmental. However, the character of the for-proﬁts has changed since the mid-1960s, with ownership by large, powerful, publicly traded investor-owned ﬁrms replacing ownership by local entrepreneurs (often doctors) as the predominant for-proﬁt form, and with the average for-proﬁt facility being larger as measured by the number of beds.
There are, however, a number of signs that the US health care system is moving toward an increased for-proﬁt character. Even among hospitals, where the nonproﬁt share has been stable at 60 percent for 30 years, a shift toward for-proﬁt has occurred beneath the surface. First, if beds rather than hospitals is used as the measure, the for-proﬁt share of acute-care hospitals doubled between the mid-1960s and the mid- 1990s (from 6 percent to 12 percent, largely at the expense of public hospitals). Second, even with hospitals as the unit of analysis, if one includes nonproﬁt and public hospitals that are managed by for-proﬁt ﬁrms, as well as non-acute care hospitals (e.g., psychiatric and rehabilitation facilities), the for-proﬁt sector among hospitals grew to about 25 percent of the total by the late 1990s.
Great increases in for-proﬁt ownership have occurred elsewhere in the US health care system since the 1980s, as is shown in Table 2. Health maintenance organizations (HMOs), which were almost exclusively nonproﬁt in 1980, are now predominantly for-proﬁt (Gray 1999). Strong trends in the for-proﬁt direction also occurred among home health agencies and dialysis treatment centers. Within the trend toward forproﬁt ownership has been a second trend—ownership not by individual proprietors but by investor-owned corporations that own multiple units (Institute of Medicine 1986, Corrigan et al. 1997). Similar trends toward multi-institutional arrangements have also occurred among nonproﬁts. This, along with increased entrepreneurial activity by nonproﬁts (Sloan 1998) has led to concerns among many observers that the character of many nonproﬁt health care organizations has changed in ways that mirror the for-proﬁts.
Comparing the cases of community hospitals and HMOs, some of the factors that are involved in the persistence and change in ownership patterns among health care organizations can be seen (Gray 1999). On the side of persistence, many nonproﬁt hospitals, with their multiple important community roles (care giver, employer) and their governing boards often made up of prominent citizens, have received both charitable and governmental support in bad economic times. The diﬃculty of closing a nonproﬁt hospital has been frequently noted in health policy circles as hospital occupancy has declined since the 1980s. Nonproﬁts have also engaged in a variety of strategies to compete and grow—entering into multihospital systems, merging, joint-venturing, and establishing for-proﬁt subsidiaries. Use of these strategies has carried a price, however. The increased commercialism of the nonproﬁts has attracted criticism and fanned doubts about their deservedness of tax exemption.
The most important factor aﬀecting the ownership composition of the health care ﬁeld is public policy. It could hardly be otherwise since the basic corporate structures of for-proﬁt and nonproﬁt organizations are themselves products of public policy. But the role that public policy plays in inﬂuencing the composition and performance of health care organizations has become increasingly apparent since the 1950s. The creation and growth of the investor-owned hospital industry was a direct result of capital reimbursement policies built into the Medicare legislation in 1965 (Gray 1992). The interest costs incurred in borrowing money to purchase hospitals was a reimbursable expense under Medicare, and gave purchasers annual payments for the noncash expense called depreciation. Since Medicare payments to hospitals were based on reimbursing them for costs incurred, the legislation also provided for giving for-proﬁt hospitals generous ‘return-on-equity’ payments so that investors would receive a return on their investments. All of these provisions stimulated the growth of the investor owned companies into the early 1980s, when, in separate actions, Congress reduced return-on-equity payments and changed the depreciation rules so that Medicare would pay for the depreciation of any particular asset only once. After these changes were made, the leading investor-owned companies all stopped growing at a time in which it was being predicted that they were going to take over the system.
Similarly, the growth of the nonproﬁt HMO industry in the 1970s and the for-proﬁt transformation of the ﬁeld in the 1980s were direct results of public policy. First, provisions of the HMO Act of 1973 made capital available to nonproﬁt HMOs. But the ﬁeld was transformed in the for-proﬁt direction in the 1980s as a result of the Reagan administration’s decision to phase out the HMO Act’s support of nonproﬁt HMOs and to undertake a program to stimulate investment in for-proﬁt HMO companies, which had not previously existed; a surge in demand for managed care from the corporate sector which was experiencing large increases in health care costs; and inattentive state regulators who allowed many nonproﬁt HMOs to be acquired for a pittance by their leadership and converted into for-proﬁt organizations (Gray 1999).
Permissive state regulation also created the environment for a surge in the acquisition of nonproﬁt hospitals by large investor-owned ﬁrms (Columbia HCA, Tenet) in the early and mid-1990s (Gray 1997). This, along with conversions involving HMOs and state Blue Cross insurance companies, led more than 25 states to pass legislation in the late 1990s to regulate nonproﬁt conversions. Some 120 new foundations were created in the 1980s and 1990s from the proceeds of the sale of nonproﬁt health care organizations (Isaacs et al. 1997). Studies of the consequences of hospital conversions have generally shown them to have occurred among ﬁnancially troubled institutions and that few negative consequences could be documented, either because the institutions had previously engaged in only low levels of charitable activity or because strong contractual protections had been built into the sales agreement (Mark 1999, Young and Desai 1999). Interestingly, there have also been examples of for-proﬁt hospitals that reverted to the control of nonproﬁt organizations, though the trend remains in the direction of greater for proﬁts.
The American health care experience has shown that for-proﬁts and nonproﬁts can coexist in the same ﬁeld. It has also shown that the comparative performance of the two forms of organizations are inﬂuenced by contextual factors such as the incentive structures built into the systems by which they are paid, regulatory regimes, professional values, and public expectations. Although for-proﬁts generally appear to be more responsive to economic incentives than are nonproﬁts, nonproﬁts cannot be indiﬀerent to economic realities. It is increasingly apparent that policymakers need to pay attention to the characteristics of the organizations that provide health services as they design programs, payment systems, and regulatory structures to achieve desired health policy goals.
The US experience also shows that the for-proﬁt nonproﬁt composition of ﬁelds can change, sometimes quite rapidly, as can the ownership form of particular organizations. In a policy-sensitive ﬁeld such as health care, the future of for-proﬁt and nonproﬁt health care organizations is likely to be aﬀected quite substantially by public policies. These policies may be focused speciﬁcally on some aspect of the ownership issue, but the most important ones may have an ownership neutral motivation, such as the desire to control costs in large governmental programs. For segments of the health care industry in which government is the dominant payer, it may be diﬃcult for investor-owned companies to generate revenues in the long run that will be satisfactory to investors. High proﬁtability is likely to lead to cuts in the programs that fund that proﬁtability. For-proﬁts also face suspicion that has been driven by highly publicized fraud-related scandals involving some leading health care companies, plus widespread distrust of the predominantly forproﬁt HMO industry.
For their part, nonproﬁts face a twin challenge. In a highly competitive health care system dominated by large purchasers and without direct governmental subsidies, they must perform well enough economically to be able to continue paying their bills and to maintain their access to capital, which depends upon lenders’ conﬁdence in their ability to repay their debts. As they do this, they must also contend with a growing skepticism, fed in part by their own economically driven policies and practices, regarding whether they engage in suﬃcient charitable activity to deserve the tax-related beneﬁts they receive.
With health care accounting for almost 15 percent of the US economy, investor money is likely to be available to fund new ideas for making money from the provision of health services, and there is interest among American companies in making investments in other countries as well. The clear advantages that the for-proﬁt form might oﬀer are the ability to raise capital, a willingness to take risks and innovate, and, perhaps, a reservoir of experience that might be transferable into new contexts. But will countries that have had little experience with this organizational form in their health care system ﬁnd such factors outweigh possible costs in terms of a changed ethos of the health care system, major shifts in power and control, and potential serious problems of exploitation of the informational asymmetries that typify health care?
- Arrow K 1963 Uncertainty and the welfare economics of health care. American Economic Review 53: 941–73
- Claxton G, Feder J, Shactman D, Altman S 1997 Public policy issues in nonproﬁt conversions: An overview. Health Aﬀairs 16: 9–28
- Corrigan J M, Eden J S, Gold M R, Pickreign J D 1997 Trends toward a national health care marketplace. Inquiry 34: 11–28
- Fox D M, Schaﬀer D C 1991 Tax administration as health policy: Hospitals, the IRS, and the courts. Journal of Health Politics, Policy, and Law 16: 251–79
- Frank R G, Salkever D S, Mullan F 1990 Hospital ownership and the care of uninsured and Medicaid patients: Findings from the National Hospital Discharge Survey 1979–1984. Health Policy 14: 1–11
- Gray B H 1992 The Proﬁt Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Harvard University Press, Cambridge, MA
- Gray B H 1997 Conversions of HMOs and hospitals: What’s at stake? Health Aﬀairs 16: 29–43
- Gray B H 1999 The changing face of health care. In: Clotfelter C T, Ehrlich T (eds.) Philanthropy and the Nonproﬁt Sector in a Changing America. Indiana University Press, Bloomington, IN
- Gray B H, Carrino G, Collins S, Gusmano M 1999 The Empirical Literature Comparing For-Proﬁt and Nonproﬁt Hospitals, Managed Care Organizations, and Nursing Homes: Updating the Institute of Medicine Study. The New York Academy of Medicine, New York
- Hansmann H 1980 The role of nonproﬁt enterprise. The Yale Law Journal 89: 835–901
- Hartz A J 1989 Hospital characteristics and mortality rates. The New England Journal of Medicine 321(25): 1720–5
- Hawes C, Phillips C D 1986 The changing structure of the nursing home industry and the impact of ownership on quality, cost, and access. In: Institute of Medicine (ed.) ForProﬁt Enterprise in Health Care. National Academy Press, Washington, DC
- Himmelstein D U, Woolhandler S, Hellander I, Wolfe S M 1999 Quality of care in investor-owned vs not-for-proﬁt HMOs. Journal of the American Medical Association 282: 159–63
- Institute of Medicine 1986 For-Proﬁt Enterprise in Health Care. National Academy Press, Washington, DC
- Isaacs S L, Beatrice D F, Carr W 1997 Health care conversion foundations: A status report. Health Aﬀairs 16: 228–36
- Kuhn E M, Hartz A J, Krakauer H, Bailey R C, Rimm A A 1994 The relationship of hospital ownership and teaching status to 30 and 180-day adjusted mortality rates. Medical Care 32(11): 1098–108
- LeBlanc A J, Hurley R E 1995 Adoption of HIV-related services among urban US hospitals: 1988 and 1991. Medical Care 33(9): 881–91
- Lewin L S, Eckels T J, Miller L B 1988 Special report. Setting the record straight: The provision of uncompensated care by not-for-proﬁt hospitals. The New England Journal of Medicine 318(18): 1212–16
- Mark T L 1999 Analysis of the rationale for, and consequences of, nonproﬁt and for-proﬁt ownership conversions. Health Services Research 34(1): 83–101
- Marmor T R, Schlesinger M, Smithey R W 1987 Nonproﬁt organizations and health care. In: Powell W W (ed.) The Nonproﬁt Sector: A Research Handbook. Yale University Press, New Haven, CT
- Norton E C, Staiger D O 1994 How hospital ownership aﬀects access to care for the uninsured. RAND Journal of Economics 25: 171–85
- Powell W W (ed.) 1987 The Nonproﬁt Sector: A Research Handbook. Yale University Press, New Haven, CT
- Powell W W, Clemens E S (eds.) 1998 Private Action and the Public Good. Yale University Press, New Haven, CT
- Rodwin M A, Okamoto A 2000 Physicians’ conﬂicts of interest in Japan and the United States: Lessons for the United States. Journal of Health Politics, Policy, and Law 25: 343–75
- Salamon L M, Anheier H K, List R, Toepler S, Sokolowski S W 1999 Global Civil Society: Dimensions of the Nonproﬁt Sector. Johns Hopkins Center for Civil Society Studies, Baltimore, MD
- Schlesinger M 1998 Mismeasuring the consequences of ownership: External inﬂuences and the comparative performance of public, for-proﬁt, and private nonproﬁt organizations. In: Powell W W, Clemens E S (eds.) Pri ate Action and the Public Good. Yale University Press, New Haven, CT
- Schlesinger M, Bentkover J, Blumenthal D, Musacchio R, Willer J 1987 Privatization of health care and physician’s perceptions of access to hospital services. The Milbank Quarterly 65(1): 25–58
- Shortell S M, Morrison E M, Hughes S L, Friedman B S, Vitek J L 1987 Diversiﬁcation of health care services: The eﬀects of ownership, environment, and strategy. Advances in Health Economics and Health Services Research 7: 3–40, 111–14
- Simon J G 1987 The tax treatment of nonproﬁt organizations: A review of federal and state policies. In: Powell W W (ed.) The Nonproﬁt Sector: A Research Handbook. Yale University Press, New Haven, CT
- Sloan F A 1998 Commercialism in nonproﬁt hospitals. In: Weisbrod B A (ed.) To Proﬁt or Not to Proﬁt. Cambridge University Press, Cambridge, UK
- Sloan F A, Picone G A, Taylor D H, Chou S Y 2000 Hospital ownership and cost and quality of care: Is there a dimes’ worth of diﬀerence? Journal of Health Economics forthcoming
- Starr P 1982 The Social Transformation of American Medicine. Basic Books, New York
- Stevens R 1989 In Sickness and in Wealth: American Hospitals in the Twentieth Century. Basic Books, New York
- Stocker K, Waitzkin H, Iriart C 1999 The exportation of managed care to Latin America. The New England Journal of Medicine 340(14): 1131–6
- Weisbrod B A 1990 The Nonproﬁt Economy. Harvard University Press, Cambridge, MA
- Young G J, Desai K R 1999 Nonproﬁt hospital conversions and community beneﬁts: New evidence from three states. Health Aﬀairs 18(5): 146–55