Ownership-related Differences Research Articles

Pet ownership-related differences in medical and long-term care costs among community-dwelling older Japanese.

This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services.

China's energy saving potential from the perspective of energy efficiency advantages of foreign-invested enterprises

The paper investigates the energy saving potential associated with firm ownership-related differences in energy efficiency such as those between domestically and foreign-owned firms. Because of a gap in official statistics this topic has barely been touched upon in the scholarly literature. This paper employs a new energy input–output table that distinguishes firm ownership (Chinese owned enterprises, COEs; and foreign-invested enterprises, FIEs) and trade mode (export processing and normal goods production) to analyze the energy efficiency advantage of FIEs in China in 2007. The results show that the total energy intensities of COEs in the industrial sector are generally 5%–35% higher than that of FIEs across industry groups. At an aggregate level, China could save up to 20.3% of its energy use, if industrial COEs could duplicate the energy use efficiency and production technology of FIEs. This gain would require major technology upgrades among COEs.

Dialysis Chains and Placement on the Waiting List for a Cadaveric Kidney Transplant

The proliferation of multi-unit for-profit dialysis chains in the ESRD industry has raised concerns for patient quality of care including access to renal transplantation therapy (RTT). The effect of dialysis facility chain status on RTT is unknown. Data from the United States Renal Data System were used to identify 4,465 dialysis facilities and 56,714 dialysis patients who started hemodialysis in 2006. Patients were followed from initiation of hemodialysis in 2006 to placement on the renal transplant waiting list or to December 31, 2009. The role of dialysis facility chain status (affiliation, size, and ownership) on placement on the renal transplant waiting list was evaluated by multi-level mixed-effect regression models that account for clustering within facilities. Patients from for-profit chain facilities, compared to nonprofit chain facilities, were 13% (95% CI 0.77-0.98) less likely to be waitlisted. In contrast, among nonchains, facility ownership did not influence likelihood of being waitlisted. There was also a marginally significant difference in waiting list placement by chain size: large chains compared with mid or small chains were 8% (95% CI 0.84-1.00) less likely to place patients on the waiting list. After adjustment for patient and facility characteristics, dialysis facility chain affiliation (chain-affiliated or not) was not found to be independently associated with the likelihood of placement on the transplant waitlist. Dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list. For-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants.

Are religiously affiliated hospitals more than just nonprofits? A study on stereotypical patient perceptions and preferences.

Recent research on patients' perceptions of different hospitals predominantly concentrates on whether hospitals are nonprofit or for-profit. Nonprofit hospitals can be subdivided into hospitals that are affiliated with a religious denomination and those that are not. Referring to the stereotypic content model, this study analyzes patients' perceptions of religious hospitals based on the factors of warmth, competence, trustworthiness and Christianity. Using a survey of German citizens (N=300) with a one-factorial between-subject design (for-profit vs. nonprofit vs. religious nonprofit), we found that religious affiliation increases the perceptions of hospitals' trustworthiness and attractiveness. The study indicated that patients' perceptions of nonprofit hospitals with a religious affiliation differ from patients' beliefs about nonprofit hospitals without a religious affiliation, implying that research into ownership-related differences must account for hospital subtypes. Furthermore, religious hospitals that communicate their ownership status may have competitive advantages over those with a different ownership status.

National Hospice Survey Results

IMPORTANCE The impact of the substantial growth in for-profit hospices in the United States on quality and hospice access has been intensely debated, yet little is known about how for-profit and nonprofit hospices differ in activities beyond service delivery. OBJECTIVE To determine the association between hospice ownership and (1) provision of community benefits, (2) setting and timing of the hospice population served, and (3) community outreach. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey (the National Hospice Survey), conducted from September 2008 through November 2009, of a national random sample of 591 Medicare-certified hospices operating throughout the United States. EXPOSURES For-profit or nonprofit hospice ownership. MAIN OUTCOMES AND MEASURES Provision of community benefits; setting and timing of the hospice population served; and community outreach. RESULTS A total of 591 hospices completed our survey (84% response rate). For-profit hospices were less likely than nonprofit hospices to provide community benefits including serving as training sites (55% vs 82%; adjusted relative risk [ARR], 0.67 [95% CI, 0.59-0.76]), conducting research (18% vs 23%; ARR, 0.67 [95% CI, 0.46-0.99]), and providing charity care (80% vs 82%; ARR, 0.88 [95% CI, 0.80-0.96]). For-profit compared with nonprofit hospices cared for a larger proportion of patients with longer expected hospice stays including those in nursing homes (30% vs 25%; P = .009). For-profit hospices were more likely to exceed Medicare's aggregate annual cap (22% vs 4%; ARR, 3.66 [95% CI, 2.02-6.63]) and had a higher patient disenrollment rate (10% vs 6%; P < .001). For-profit were more likely than nonprofit hospices to engage in outreach to low-income communities (61% vs 46%; ARR, 1.23 [95% CI, 1.05-1.44]) and minority communities (59% vs 48%; ARR, 1.18 [95% CI, 1.02-1.38]) and less likely to partner with oncology centers (25% vs 33%; ARR, 0.59 [95% CI, 0.44-0.80]). CONCLUSIONS AND RELEVANCE Ownership-related differences are apparent among hospices in community benefits, population served, and community outreach. Although Medicare's aggregate annual cap may curb the incentive to focus on long-stay hospice patients, additional regulatory measures such as public reporting of hospice disenrollment rates should be considered as the share of for-profit hospices in the United States continues to increase.

Does Ownership Matter Under Challenging Conditions?: On the relationship between organizational entrepreneurship and performance in the healthcare sector

This research explores how organizational entrepreneurship (proactiveness, innovativeness and risk-taking) in the health care sector affects hospital performance. We thereby consider heterogeneity in ownership and environmental conditions. To empirically investigate the relationships proposed by theory, a nation-wide survey was conducted generating a sample of 152 hospitals. Results show that organizational entrepreneurship is positively related to hospital performance. Furthermore, it is significantly influenced by both ownership and environment, whereas the entrepreneurship-performance link is independent of any environmental conditions. Our study creates important insight into ownership-related differences of entrepreneurship and gives strong arguments for an entrepreneurial behaviour of hospitals.

MODELING INTERNAL DECISION MAKING PROCESS: AN EXPLANATION OF CONFLICTING EMPIRICAL RESULTS ON BEHAVIOR OF NON-PROFIT AND FOR-PROFIT HOSPITALS

I. INTRODUCTION The prevalence of for-profit hospitals has increased in the United States over the past few decades. The emergence of for-profit hospitals that often compete in markets with not-for-profit hospitals has generated vigorous academic and policy debates about the implications of the distinct legal and organizational for-profit and non-profit forms on hospital behavior. The main issues arise from differences in monetary and non-pecuniary incentives for administrators and physicians that are associated with organizational form, including variations in tax treatment, access to capital markets, and governance structures. These debates center on two possible outcomes related to organizational form and ownership mix. One is whether these differences lead to observable differences in revenues and costs as well as the quantity, quality, and mix of services provided by for-profit and non-profit hospitals (NPHs). The other possible outcome is whether competition from for-profit hospitals in the same markets as NPHs coupled with persistent cost-containment efforts of public and private insurers, results in a form of convergence where NPHs behave similarly to for-profit hospitals despite differences in organizational form. This notion of convergence that has arisen in the literature on performance in the hospital industry has called into question both academically and for policy makers the tax benefits that NPHs enjoy on the grounds that NPHs are indistinguishable from for-profit hospitals and fail to provide community benefits at a level sufficient to justify the subsidies. (1) The ongoing debate about whether NPHs behave differently from for-profit hospitals has given rise to a substantial empirical literature seeking to inform the debate. Schlesinger and Gray (2006) and Rosenau (2003) comprehensively reviewed the empirical evidence on the performance differences between for-profit and NPHs. Performance is evaluated along several dimensions including economic measures like cost per admission, revenue or charge per admission, technical efficiency, non-pecuniary measures like quality, provision of care to indigent patients, and trustworthiness of organizational practices. Both reviews conclude that ownership-related differences in hospital behavior and outcomes are mixed. Schlesinger and Gray reviewed 162 empirical studies comparing non-profit and for-profit hospitals and nursing homes along the dimensions of economic performance, quality of care, and indigent patients' access to care. (2) In terms of economic performance, 18 studies found no significant differences between for-profit and NPHs; 10 studies found an advantage for profit-making hospitals (PMHs); and 30 found an advantage for NPHs. Twenty-one studies reported no significant differences between for-profit and NPHs in terms of quality of care, whereas 4 studies found higher quality of care in for-profit hospitals, and 19 studies found higher quality of care in NPHs. Rosenau synthesized the results of approximately 75 peer-reviewed studies published between 1985 and 2001 along quality, cost, access, and charity care dimensions. (3) In terms of cost, 23 studies found NPHs to be superior, 5 studies found for-profit hospitals to be superior, and 9 studies were inconclusive. Twelve studies found that NPHs provided higher quality care, 3 studies found quality of care to be higher in for-profit hospitals, and 9 studies found no differences in quality. Their finding that evidence of ownershiprelated differences in cost, quality, profits, pricing policies, technical efficiency, access to care, and service offerings vary greatly across empirical studies is not surprising because the studies themselves vary in terms of data used and statistical methods. The empirical approach taken in the majority of the studies is to estimate a reduced-form model of hospital characteristics that typically includes an indicator variable for ownership status as a control variable. …

The Impact of State Community Benefit Laws on the Community Health Orientation and Health Promotion Services of Hospitals

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levene's test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.

Nonprofit Ownership and Quality in Mddicaid's Long-Term Care Program for Persons with Developmental Disabilities

To assess ownership-related differences in the Intermediate Care Facility Program for persons with Mental Retardation (ICF/MR) Industry, this article analyzes a nationally representative sample of data on Medicaid certified facilities from the Health Care Financing Administration On-line Survey and Certification Reporting System. This study found that nonprofit providers provided a higher level of quality than for-profit facilities when organizational size and facility-mix were controlled. The size and case-mix composition of these facilities were also influenced by nonprofit ownership type. Nonprofit providers offered smaller facilities, on average, and were more likely to enroll heavy case-mix residents than their for-profit counterparts.

Access, Hospital Ownership, and Competition between For-Profit and Nonprofit Institutions

The authors argue that past studies of ownership inadequately control for the ways in which competition alters ownership-related differences. Survey data from 1975, 1980, and 1986 are used to estimate the changing effect of hospital ownership and between-sector competition on access to inpatient psychiatric care over a period when for-profit competition was increasing. Results show that during the noncompetitive period (1975), nonprofit psychiatric hospitals were more willing to admit costly patients. As cross-ownership competition increased, nonprofit hospitals became more willing to admit uninsured and underinsured patients, but they also grew more sensitive to cost of care. For-profit hospitals became more sensitive to the generosity of reimbursement but less sensitive to cost of care.

Trust, repute and the role of non-profit enterprise

This article examines the trust hypothesis: the claim that asymmetric information can explain the existence of non-profit enterprise in certain markets. We argue that this hypothesis, in order to be viable, has to meet three challenges: ‘reputational ubiquity’, ‘incentive compatibility’ and ‘adulteration’. Drawing on modern agency theory, we conclude that the trust hypothesis stands on shaky ground. It can be sustained only under particular conditions that have been neither carefully described in theory nor subject to empirical assessment. The available evidence, patchy and inadequate as it is, seems to suggests that there are some ownership-related differences in aspects of organisational performance connected with asymmetric information. However, there is little evidence that this relates to trustper se or provides a rationale for the existence of non-profit ownership in these industries. We conclude with a plea for substantial research on consumer expectations and provider motivations.

Charity and community: the role of nonprofit ownership in a managed health care system.

As American medicine has been transformed by the growth of managed care, so too have questions about the appropriate role of nonprofit ownership in the health care system. The standards for community benefit that are increasingly applied to nonprofit hospitals are, at best, only partially relevant to expectations for nonprofit managed care plans. Can we expect nonprofit ownership to substantially affect the behavior of an increasingly competitive managed care industry dealing with insured populations? Drawing from historical interpretations of tax exemption in health care and from the theoretical literature on the implications of ownership for organizational behavior, we identify five forms of community benefit that might be associated with nonprofit forms of managed care. Using data from a national survey of firms providing third-party utilization review services in 1993, we test for ownership-related differences in these five dimensions. Nonprofit utilization review firms generally provide more public goods, such as information dissemination, and are more "community oriented" than proprietary firms, but they are not distinguishable from their for-profit counterparts in addressing the implications of medical quality or the cost of the review process. However, a subgroup of nonprofit review organizations with medical origins are more likely to address quality issues than are either for-profit firms or other nonprofit agencies. Evidence on responses to information asymmetries is mixed but suggests that some ownership related differences exist. The term "charitable" is thus capable of a definition far broader than merely the relief of the poor. While it is true that in the past Congress and the federal courts have conditioned the hospital's charitable status on the level of free or below cost care that it provided for indigents, there is no authority for the conclusion that the determination of "charitable" status was always so limited. Such an inflexible construction fails to recognize the changing economic, social and technological precepts and values of contemporary society. -Circuit Court of Appeals, District of Columbia, Eastern Kentucky Welfare Rights Organization v. Simon (1974).

A national study of psychiatric hospital care

The delivery system for psychiatric inpatient services in the United States has changed dramatically over the past 30 years, undergoing a marked privatization. To assess the effect of changes in ownership and types of inpatient settings on the structure of the mental health services system, the authors surveyed a national sample of nonfederal mental health facilities in 1988. Comparing their data to those of earlier surveys, they found that a decline in the number of patients per staff occurred in most settings over the last decade, suggesting that this aspect of quality of care may have improved. They observed important ownership-related differences in 1988 in diagnostic mix (e.g., more schizophrenia treated in public facilities than in private ones) and in payer source (e.g., more third-party revenues in public facilities than occurred in the past). There was a significant interaction between ownership form and type of facility, suggesting that the type of inpatient setting, ownership, and the relation between the two should be considered in assessing the impact of privatization on the accessibility of health care available for the mentally ill. The authors found that the increase in private psychiatric hospitals has widened the availability and choice of treatment facilities for those with private funding sources (especially children and adolescents) but has not had a similar effect in increasing sources of care for the seriously mentally ill dependent upon public financing.

Ownership, Costs, and Facility Characteristics in the National Long-Term Health Care Industry

The rapid rise in long-term health care costs has become a matter of national concern. Recognizing the national trend toward fiscal responsibility, policy makers have become interested in methods of controlling costs without sacrifices in care. One area of interest is the effect of facility ownership on facility perform ance. For-profit facilities have generally been found to provide care at lower costs than non-profit facilities. Given such results, it is important to find whether there are any significant ownership-related differences in facility characteristics associated with these cost differences. This study examines data from the 1977 National Nursing Home Survey. It is found that for-profit skilled nursing facilities are lower cost than non-profit or government facilities. Further it is found that organizational form affects facility costs. Facility size, location, resident mix, and aspects of facility quality are found to be meaningfully associated with facility ownership-related and organization-related cost differences.