As tax-exempt entities that compete in commercial markets with for-profit organizations, nonprofit health care organizations present stimulating intellectual challenges to the theorist and the empiricist alike. Because of third-party payment and policy intensiveness of health care, much information is available to researchers. Most research has focused on comparisons with for-profits and on public policy issues. This article describes the major streams of research on health care delivery organizations and the main sources and types of data that are available to researchers. We suggest criteria for evaluating data sources and identify some limitations and barriers that now exist. We conclude by identifying and assessing the data problems that could confront researchers interested in ownership issues in health care and by offering suggestions on how the more serious ones might be addressed to facilitate improved research.
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References
1.
Aaronson, W. E. , Zinn, J. S., & Rosko, M. D. (1994). Do for-profit and not-for-profit nursing homes behave differently. The Gerontologist, 34(6), 775-786.
2.
Arnould, R. A. , Bertrand, M., & Hallock, K. F. (2000, July). Does managed care change the mission of nonprofit hospitals? Evidence from the managerial labor market (NBER Working Paper 7924). Cambridge, MA: National Bureau Of Economic Research.
3.
Arrington, B. , & Haddock, C. C. (1990). Who really profits from non-profits?Health Services Research, 25(2), 291-304.
4.
Barnett, K. (1997). The future of community benefit programming. Berkeley, CA: The Public Health Institute and the Western Consortium for Public Health.
5.
Bazzoli, G. J. , Chan, B., Shortell, S. M., & D'Aunno, T. (2000). The financial performance of hospitals belonging to health networks and systems. Inquiry, 37(3), 234-252.
6.
Bell, J. E. (1996). Saving their assets: How to stop plunder at Blue Cross and other nonprofits. The American Prospect, 26, 60-66.
7.
Born, P. H. , & Simon, C. J. (2001). Patients and profits: The relationship between HMO financial performance and quality of care. Health Affairs, 20(2), 167-174.
8.
Boscarino, J. A. (2000). Nontraditional services provided by nonprofit and for-profit hospitals: Implications for community health. Journal of Healthcare Management, 45, 123-140.
9.
Buczko, W. (1994). Factors affecting charity care and bad debt charges in Washington hospitals. Hospital & Health Services Administration, 39(2), 179-191.
10.
Carpenter, C. E. (1992). Determinants of hospital tax-exempt debt yields: Corrections for selection and simultaneous equation bias. Health Services Research, 25(5), 695-713.
11.
Caswell, R. J. , & Cleverley, W. O. (1983). Cost analysis of the Ohio nursing home industry. Health Services Research, 18(3), 359-382.
12.
Clement, J. P. , McCue, M. J., Luke, R. D., Bramble, J. D., Rossiter, L. F., Ozcan, Y. A., & Pai, C. W. (1997). Strategic hospital alliances: Impact on financial performance. Health Affairs, 16(6), 193-203.
13.
Clement, J. P. , Smith, D. G., & Wheeler, J.R.C. (1994). What do we want and what do we get from not-for-profit hospitals?Hospital & Health Services Administration, 39(2), 159-178.
14.
Coalition for Nonprofit Health Care . (1999). Redefining the community benefit standard: State law approaches to ensuring the social accountability of nonprofit health care organizations. Washington, DC: Author.
15.
Collins, S. R. , Gray, B. H., & Hadley, J. (2001). The for-profit conversion of nonprofit hospitals in the U.S. health care system: Eight case studies. New York: The Commonwealth Fund.
16.
Connor, R. A. , Feldman, R. D., Dowd, B. E., & Radcliff, T. A. (1997). Which types of hospital mergers save consumers money?Health Affairs, 16(6), 62-74.
17.
Cowles, C. M. (1999). Nursing home statistical yearbook (p. 72). Washington, DC: American Association of Homes and Services for the Aging.
18.
Cutler, D. M. , & Horwitz, J. R. (2000). Converting hospitals from not-for-profit to for-profit status: Why and what effects? In D. Cutler (Ed.), The changing hospital industry (pp. 45-79). Chicago: University of Chicago Press.
19.
Desai, K. R. , Young, G. J., & Van Deusen Lukas, C. (1998). Hospital conversions from for-profit and nonprofit status: The other side of the story. Medical Care Research & Review, 55(3), 298-308.
20.
DiMaggio, P. J. , & Anheier, H. K. (1990). The sociology of nonprofit organizations and sectors. Annual Review of Sociology, 16, 137-159.
21.
Dorwart, B. A. , Schlesinger, M., Davidson, H., Epstein, S., & Hoover, C. (1991, February). A national study of psychiatric hospital care. American Journal of Psychiatry, 148, 204-210.
22.
Eldenburg, L. , Hermalin, B. E., Weisbach, M. S., & Woskinska. M. (2001, April). Hospital governance, performance objectives, and organizational form (NBER Working Paper No. 8201). Cambridge, MA: National Bureau of Economic Research.
23.
Ettner, S. L. , & Hermann, R. C. (2001). The role of profit status under imperfect information: Evidence from the treatment patterns of elderly Medicare beneficiaries hospitalized for psychiatric diagnoses. Journal of Health Economics, 20, 23-49.
24.
Federal Trade Commission. (2001, July). Department of Justice and Federal Trade Commission statements of antitrust enforcement policy in health care. Retrieved from www.ftc.gov/reports/hlth3s.htm
25.
Fox, D. M. , & Isenberg, P. (1996). Anticipating the magic moment: The public interest in health plan conversions in California. Health Affairs, 15(1), 202-209.
26.
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(2), 251-279.
27.
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.
28.
Fremont-Smith, M. R. , & Lever, J. A. (2000). State regulation of health care conversions and conversion foundations. The BNA Analysis & Perspective, 9(19), 714-720.
29.
Gaynor, M. , & Vogt, W. B. (2000). Antitrust and competition in health care markets. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics (pp. 1405-1487). Amsterdam, the Netherlands: Elsevier Science.
30.
Grantmakers in Health. (2001). A profile of new health foundations. Washington, DC: Author.
31.
Gray, B. H. (1991). The profit motive and patient care. Cambridge, MA: Harvard University Press.
32.
Gray, B. H. (1997a). Conversions of HMOs and hospitals: What's at stake?Health Affairs, 16(2), 29-47.
33.
Gray, B. H. (1997b). Conversion of HMOs and hospitals: What's at stake? (Working Paper No. 238, Program on Nonprofit Organizations, Institution for Social and Policy Studies). New Haven, CT: Yale University Press.
34.
Gray, B. H. , & Schlesinger, M. (in press). Health. In L. Salamon (Ed.), The state of the nonprofit sector. Bloomington: Indiana University Press.
35.
Gruber, J. (1994). The effect of competitive pressure on charity: Hospital responses to price shopping in California. Journal of Health Economics, 38, 183-212.
36.
Gusmano, M. K. , Montero, G., & Gray, B. H. (2001, July). The regulation of nonprofit hospital community benefits: The origin and evolution of state programs. New York: The Surdna Foundation.
37.
Hansmann, H. B. (1980). The role of nonprofit enterprise. Yale Law Journal, 89(5), 835-901.
38.
Hansmann, H. B. (1987). Economic theories of nonprofit organization. In W. W. Powell (Ed.), The nonprofit sector: A research handbook (pp. 27-42). New Haven, CT: Yale University Press.
39.
Harrington, C. , Woolhandler, S., Mullan, J., Carillo, H., & Himmelstein, D. U. (2001). Does investor-ownership of nursing homes compromise the quality of care?American Journal of Public Health, 91(9), 1452-1455.
40.
Hartz, A. , Krakauer, H., Kuhn, E., Young, M., Jacobsen, S. J., Gay, G., Muenz, L., Katzoff, M., Bailey, R. C., & Rimm, A. (1989). Hospital characteristics and mortality rates. New England Journal of Medicine, 321, 1720-1725.
41.
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 B. H. Gray (Ed.), For-profit enterprise in health care (pp. 492-541). Washington, DC: National Academy Press.
42.
Health Affairs . (1997). Hospital & Health Plan Conversions. Health Affairs, 16(2).
43.
Healthcare Financial Management Association . (2001). Principles and practices. Board statement Number 15: Valuation and financial statement presentation of charity service and bad debts by institutional healthcare providers. Washington, DC: Healthcare Financial Management Association.
44.
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, 159-163.
45.
Hirth, R. A. , Chernew, M. E., & Orzol, S. M. (2000). Ownership, competition, and the adoption of new technologies and cost-saving practices in a fixed price environment. Inquiry, 37, 282-294.
46.
Holmes, J. S. (1996). The effects of ownership and ownership change on nursing home industry costs. Health Services Research, 31(3), 327-346.
47.
Iglehart, J. K. (1996). The National Committee for Quality Assurance. New England Journal of Medicine, 335(13), 995-999.
48.
Keeler, E. B. , Melnick, G., & Zwanziger, J. (1999). The changing effects of competition on non-profit and for-profit hospital pricing behavior. Journal of Health Economics, 18, 69-86.
49.
Kovner, C. , & Gergen, P. (1998). Nursing staff levels and adverse events following surgery in U.S. hospitals. Image: Journal of Nursing Scholarship, 30(4), 315-321.
50.
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-adjusted mortality rates. Medical Care, 32, 1098-1108.
51.
Kuttner, R. (1996a). Columbia/HCA and the resurgence of the for-profit hospital business, Part 1 of 2. New England Journal of Medicine, 335(5), 362-367.
52.
Kuttner, R. (1996b). Columbia/HCA and the resurgence of the for-profit hospital business, Part 2 of 2. New England Journal of Medicine, 335(6), 446-451.
53.
Landon, B. E. , Zaslavsky, A. M., Beaulieu, N. D., Shaul, J. A., & Cleary, P. D. (2001). Health plan characteristics and consumers' assessments of quality. Health Affairs, 20(2), 274-285.
54.
Lanska, D. J. , & Kryscio, R. J. (1998). In-hospital mortality following carotid endarterectomy. Neurology, 51(2), 440-447.
55.
LeBlanc, A. J. , & Hurley, R. E. (1995). Adoption of HIV-related services among urban US hospitals: 1988 and 1991. Medical Care, 33(9), 881-891.
56.
Lewin, L. S. , Derzon, R. A., & Margulies, R. (1981). Investor-owned and nonprofits differ in economic performance. Hospitals, 55(13), 52-58.
57.
Lewin, L. S. , Eckels, T. J., & Miller, L. B. (1988). Setting the record straight. The provision of uncompensated care by not-for-profit hospitals. New England Journal of Medicine, 318(18), 1212-1215.
58.
Longo, D. R. , Chase, G. A., Ahlgren, L. A., Roberts, J. S., & Weisman, C. S. (1986). Compliance of multihospital systems with standards of the Joint Commission on Accreditaion of Hospitals. In B. H. Gray, (Ed.), For-profit enterprise in health care (pp. 375-384). Washington, DC: National Academy Press.
59.
Lynk, W. (1995). Nonprofit hospital mergers and the exercise of market power. Journal of Law and Economics, 38, 437-461.
60.
Mark, T. L. (1999). Psychiatric hospital ownership and performance: Do nonprofit organizations offer advantages in market characterized by asymmetric information?Journal of Human Resources, 31(3), 631-649.
61.
Marmor, T. R. , Schlesinger, M., & Smithey, R. W. (1987). Nonprofit organizations and health care. In W. W. Powell (Ed.), The nonprofit sector: A research handbook (pp. 221-239). New Haven, CT: Yale University Press.
62.
McClellan, M. , & Staiger, D. (2000). Comparing hospital quality at for-profit and not-for-profit hospitals. In D. M. Cutler (Ed.), The changing hospital industry (pp. 93-112). Chicago: University of Chicago Press.
63.
McCue, M. J. (1997). Association of HMO penetration and other credit quality factors with tax exempt bond yields. Inquiry, 34(3), 217-227.
64.
McCue, M. J. , & Clement, J. P. (1993). The relative performance of for-profit psychiatric hospitals in investor-owned systems and nonprofit psychiatric hospitals. American Journal of Psychiatry, 150(1), 77-82.
65.
McCue, M. J. , & Clement, J. P. (1996). Assessing the characteristics of hospital bond defaults. Medical Care, 34(11), 1121-1134.
66.
Medicare Payment Advisory Commission . (2001, March). Medicare payment policy (Report to the Congress). Washington, DC: Author.
67.
Melnick, G. , Zwanziger, J., Bamezai, A., & Pattison, R. (1992). The effects of market structure and bargaining position on hospital prices. Journal of Health Economics, 11, 217-233.
68.
Morrisey, M. A. , Wedig, G. J., & Hassan, M. (1996). Do nonprofit hospitals pay their way?Health Affairs, 15(4), 132-144.
69.
Newhouse, J. (1970). Toward a theory of nonprofit institutions: An economic model of a hospital. American Economic Review, 60(1), 64-74.
70.
Nicholson, S. , Pauly, M. V., Burns, L. R., Baumritter, A., & Asch, D. A. (2000). Measuring community benefits provided by for-profit and nonprofit hospitals. Health Affairs, 19(6), 168-177.
71.
Noble, A. A. , Hyams, A. L., & Kane, N. M. (1998). Charitable hospital accountability: A review and analysis of legal and policy initiatives. Journal of Law, Medicine & Ethics, 26(2), 116-137.
72.
Office of Statewide Health Planning and Development . (2001). Healthcare information, frequently asked questions. Sacramento, CA: Author.
73.
Pauly, M. , & Redisch, M. (1973). The not-for-profit hospital as a physician cooperative. American Economic Review, 63(1), 87-100.
74.
Potter, M. A. , & Longest, B. B., Jr. (1994). The divergence of federal and state policies on the charitable tax exemption of nonprofit hospitals. Journal of Health Politics, Policy, and Law, 19(2), 393-419.
75.
Project HOPE Center for Health Affairs . (1997). The community impact of for-profit hospital conversions (Final Report to the Federation of American Health Systems). Washington, DC: Project HOPE.
76.
Relman, A. S. (1980). The new medical-industrial complex. New England Journal of Medicine, 303(17), 963-970.
77.
Rundall, T. G. , Sofaer, S., & Lambert, W. (1988). Uncompensated hospital care in California: Private and public hospital responses to competitive market pressures. Advances in Health Economics and Health Services Research, 9, 113-133.
78.
Schlesinger, M. , & Gray, B. H. (1998). A broader vision for managed care, part 1: Measuring the benefit to communities. Health Affairs, 17(3), 152-168.
79.
Schlesinger, M. , & Gray, B. H. (in press). Nonprofit organizations and health care: A return engagement, 15 years on. In W. W. Powell & R. Steinberg (Eds.), The nonprofit sector: A research handbook (2nd ed.). New Haven, CT: Yale University Press.
80.
Schlesinger, M. , Dorwart, R., Hoover, C., & Epstein, S. (1997). Competition, ownership, and access to hospital services. Medical Care, 35(9), 974-992.
81.
Schlesinger, M. , Gray, B. H., Carrino, G., Duncan, M., Gusmano, M., Antonelli, V., & Stuber, J. (1998). A broader vision for managed care, part 2: A typology of community benefits. Health Affairs, 17(5), 26-49.
82.
Scott, W. R. , & Backman, E. V. (1990). Institutional theory and the medical care sector. In S. Mick (Ed.), Innovations in health care delivery: Insights for organization theory (pp. 20-52). San Francisco: Jossey-Bass.
83.
Scott, W. R. , Ruef, M., Mendel, P. J., & Caronna, C. A. (2000). Institutional change and healthcare organizations: from professional dominance to managed care. Chicago: University of Chicago Press.
84.
Seto, N. , & Weiskopf, B. K. (2000). Community benefits: The need for action, an opportunity for healthcare change (p. 94). Boston: Community Catalyst.
85.
Shukla, R. K. , Pestian, J., & Clement, J. (1997). A comparative analysis of revenue and cost management strategies of not-for-profit and for-profit hospitals. Hospital and Health Services Administration, 42(1), 117-134.
86.
Silverman, E. , & Skinner, J. (2001, February). Are for-profit hospitals really different? Medicare upcoding and market structure (NBER Working Paper #8133). Cambridge, MA: National Bureau of Economic Research.
87.
Sloan, F. A. (1988). Property rights in the hospital industry. In H. E. Frech (Ed.), Health care in America: The political economy of hospitals and health insurance (pp. 103-141). San Francisco: Pacific Research Institute for Public Policy.
88.
Sloan, F. A. , Picone, G. A., Taylor, D. H., Jr., & Lee, S. Y. (2001). Hospital ownership and cost and quality of care: Is there a dime's worth of difference?Journal of Health Economics, 20, 1-21.
89.
Sparrow, M. K. (2000). License to steal: How fraud bleeds America's health care system (Updated ed.). Boulder, CO: Westview.
90.
Spector, W. D. , Selden, T. M., & Cohen, J. W. (1998). The impact of ownership type on nursing home outcomes. Health Economics, 7, 639-653.
91.
Stafford, R. S. (1991). The impact of nonclinical factors on repeat Cesarean section. Journal of the American Medical Association, 265(1), 59-63.
92.
Steinberg, R. , & Gray, B. H. (1993). `The role of nonprofit enterprise' in Hansmann revisited. Non-profit and Voluntary Sector Quarterly, 22(4), 297-316.
93.
U.S. General Accounting Office . (1990). Nonprofit hospitals: Better standards needed for tax exemption (GAO/HRD-90-84). Washington, DC: Author.
94.
Weisbrod, B. A. (1988). The nonprofit economy. Cambridge, MA: Harvard University Press.
95.
Weisbrod, B. A. , & Schlesinger, M. (1986). Ownership form and behavior in regulated markets with asymmetric information. In S. Rose-Ackerman (Ed.), The nonprofit sector: Economic theory and public policy (pp. 133-151). New York: Oxford University Press.
96.
Woolhandler, S. , & Himmelstein, D. U. (1997). Cost of care and administration at for-profit and other hospitals in the United States. New England Journal of Medicine, 336(11), 769-774.
97.
Young, G. J. (1996/1997). Insider representation on the governing boards of nonprofit hospitals: Trends and implications for charitable care. Inquiry, 33, 352-362.
98.
Young, G. J. , & Desai, K. R. (1999). Nonprofit hospital conversions and community benefits: New evidence from three states. Health Affairs, 18(5), 146-155.
99.
Young, G. J. , Desai, K. R., & Hellinger, F. J. (2001). Community control and pricing patterns of non-profit hospitals: An antitrust analysis. Journal of Health Politics, Policy and Law, 25, 1051-1081.
100.
Young, G. J. , Desai, K. R., & Van Deusen Lukas, C. (1997). Does the sale of nonprofit hospitals threaten health care for the poor?Health Affairs, 16(1), 137-141.
