For-Profit Enterprise in Health Care -- Copyright -- Contents -- ACKNOWLEDGMENTS -- INTRODUCTION TO THE VOLUME -- ORIGINS OF THIS INQUIRY -- FOCUS OF THIS STUDY -- THE COMPLICATIONS OF CHANGE -- SOURCES OF INFORMATION -- THE PRODUCTS OF THIS INQUIRY -- CONCLUSION -- PART I COMMITTEE REPORT -- 1 Profits and Health Care: An Introduction to the Issues -- QUESTIONS EXAMINED IN THIS REPORT -- THE DIVERSE OWNERSHIP OF AMERICAN HEALTH CARE ORGANIZATIONS -- THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION -- Investor Ownership -- Not-For-Profit Organizations -- Problems with the For-Profit/Not-For-Profit Distinction -- THE VALUE QUESTION -- Health Care as Economic Good -- Health Care as Social Good -- Economic Good Versus Social Good -- Relationship of Physicians to Health Care Organizations -- NOTES -- References -- APPENDIX TO CHAPTER 1 -- Economic Rationale for the Three Sectors -- Models of the Behavior of For-Profit and Not-For-Profit Organizations -- Why For-Profit Hospitals May be Inefficient -- Notes -- 2 Changes in the Ownership, Control, and Configuration of Health Care Services -- HOSPITALS -- Investor-Owned Hospital Systems -- Not-For-Profit Hospital Systems -- COMPARISONS OF INVESTOR-OWNED AND NOT-FOR-PROFIT SYSTEMS -- Psychiatric Hospitals -- NURSING HOMES -- HEALTH MAINTENANCE ORGANIZATIONS -- HOME CARE -- NEW TYPES OF PROVIDERS -- Freestanding Primary Care Centers -- Other Services -- VERTICAL INTEGRATION AND DIVERSIFICATION -- FOR-PROFIT/NOT-FOR-PROFIT HYBRIDS -- CONCLUSIONS -- NOTES -- References -- 3 Financial Capital and Health Care Growth Trends -- WHAT IS CAPITAL? -- SOURCES OF CAPITAL FUNDS FOR HEALTH CARE PROVIDERS -- Trends in Sources of Financial Capital -- Relationship of Ownership to Sources of Capital -- THE COSTS OF CAPITAL -- Philanthropy and Governmental Grants -- Debt Financing -- Equity Financing.

THE LEVEL PLAYING FIELD ARGUMENT -- POLICY ISSUES REGARDING CAPITAL -- CONCLUSION -- NOTES -- References -- APPENDIX TO CHAPTER 3 -- Note -- 4 Investor Ownership and the Costs of Medical Care -- DEFINITION AND MEASUREMENT OF COSTS-AND WHO IS CONCERNED -- STUDIES OF HOSPITAL EXPENSE AND PRICING -- Expenses -- Prices -- MARKUP -- PROFITABILITY -- COSTS AND ACQUISITION OF HOSPITALS -- NURSING HOME COSTS -- OTHER FOR-PROFIT PROVIDERS -- MONITORING COST TRENDS -- CONCLUSIONS -- NOTES -- References -- 5 Access to Care and Investor-Owned Providers -- THE PROBLEM OF CARE FOR THOSE UNABLE TO PAY -- The Financing of Uncompensated Care -- THE PROVIDERS OF UNCOMPENSATED CARE -- OCR DATA -- AHA Data -- State Data -- REDUCING UNCOMPENSATED CARE -- The Impact of For-Profit Acquisition -- Cross-Subsidies and Uncompensated Care -- Other For-Profit Providers -- Types of Services in Various Hospitals -- Which Hospital Services Lose Money? -- For-Profit/Not-For-Profit Differences in Services -- Cross-Subsidies and Uncompensated Care -- ACCESS TO NURSING HOMES -- ISSUES AND RECOMMENDATIONS -- The Measurement of Care to Patients Unable to Pay -- The Need for Better Information -- The Obligations of Health Care Institutions -- The Issue of Tax Status -- The Government's Obligation for Uninsured Patients -- CONCLUSION -- NOTES -- References -- APPENDIX TO CHAPTER 5 -- 6 Quality of Care -- QUALITY OF HOSPITAL CARE -- Accreditation -- Qualifications of Medical Staff -- Nursing Personnel -- Physicians' Evaluations -- Board Chairman Evaluations -- Outcome Measures -- QUALITY OF CARE IN NURSING HOMES -- Hospitals, Nursing Homes, and Quality -- QUALITY OF CARE AND THE NEED FOR MONITORING -- CONCLUSION -- NOTES -- References -- 7 Implications for Education and Research -- TEACHING HOSPITALS AND INVESTOR-OWNED HOSPITAL COMPANIES -- Concerns About For-Profit Involvement in Education.

Research -- CONCLUSION -- NOTES -- References -- 8 Physicians and Entrepreneurism in Health Care -- ECONOMIC INCENTIVES AND ETHICAL OBLIGATIONS -- INVESTMENTS AND INCENTIVE ARRANGEMENTS -- Physicians' Investments in Health Care -- Incentive Bonus Arrangements -- THE PROBLEM: ISSUES AND OPTIONS -- The Problem -- The Evidence -- Policy Options -- Disclosure -- Curbing Benefits from Economic Linkages -- Rules Forbidding Certain Conflicts of Interest -- THE COMMITTEE'S VIEW -- CONCLUSION -- NOTES -- References -- 9 The Changing Nature of Physician Influence in Medical Institutions -- DECISION MAKING IN HOSPITALS -- PHYSICIANS' RESPONSIBILITY FOR QUALITY -- The Potential Decline of Exit Mechanisms as a Source of Influence -- The Growing Importance of Physicians' Voice as an Influence on Institutions -- Investor-Owned Health Care and the Mechanisms of Exit and Voice -- CONCLUSION -- NOTES -- References -- 10 Summary and Conclusions -- THE FOR-PROFIT/NOT-FOR-PROFIT DISTINCTION -- FINDINGS ABOUT FOR-PROFIT ENTERPRISE IN HEALTH CARE -- Health Care Costs -- Price -- Expenses -- Acquisitions and Costs -- Nonhospital Settings -- Discussion -- Access to Care -- Quality of Care -- Education and Research -- CONCLUSIONS ABOUT INVESTOR OWNERSHIP OF HEALTH CARE FACILITIES -- ISSUES, CONCLUSIONS, AND RECOMMENDATIONS -- The Increasing Importance of Economic Incentives -- The Social Responsibilities Of Health Care Organizations -- The Future of Not-For-Profit Institutions -- The Indigent Care Problem -- Financial Capital -- The Future of the Physician's Fiduciary Role -- Physicians and Entrepreneurism -- Physician Influence in Medical Institutions -- The Need for Monitoring -- CONCLUSION -- NOTES -- References -- Supplementary Statement on For-Profit Enterprise in Health Care -- PART II PAPERS ON FOR-PROFIT ENTERPRISE IN HEALTH CARE.

An Exchange on For-Profit Health Care -- Ethical Issues in For-Profit Health Care -- FOR-PROFITS EXACERBATE THE PROBLEM OF ACCESS TO HEALTH CARE -- FOR-PROFITS ARE UNFAIR COMPETITION FOR NONPROFITS -- FOR-PROFITS TREAT HEALTH CARE AS A COMMODITY TO BE BOUGHT AND SOLD IN THE MARKETPLACE RATHER THAN AS... -- FOR-PROFITS DAMAGE THE PHYSICIAN/PATIENT RELATIONSHIP, ERODE TRUST, CREATE NEW CONFLICTS OF INTEREST... -- FOR-PROFITS UNDERMINE MEDICAL EDUCATION -- FOR-PROFITS AND THE POLITICAL POWER OF THE MEDICAL-INDUSTRIAL COMPLEX -- CONCLUSION -- NOTES -- Trends in the Growth of the Major Investor-Owned Hospital Companies -- SOURCES OF GROWTH -- Growth Trends Over Time -- TYPES OF HOSPITALS ACQUIRED -- Previous Ownership -- Size of New Hospitals -- Geographic Patterns -- The Relationship Between Contract Management and Acquisition -- DIVESTITURES -- CONCLUSIONS -- NOTES -- References -- The Effects of Ownership and Multihospital System Membership on Hospital Functional Strategies and E ... -- INTRODUCTION -- METHODS -- The Sample -- Data -- Techniques -- Dependent Variables -- Independent Variables and Hypotheses -- Regression Models -- RESULTS -- Siting and Service Area Characteristics -- Urban, Suburban, and Rural -- Wage Index and Sole Community Provider Status -- Area Demographics -- Area Health Care Capacity and Utilization -- Third-Party Coverage and Rate Setting -- Discussion -- Case Mix -- Discussion -- Operating Revenues and Expenses -- Discussion -- Markups and Profitability -- Discussion -- Capital Structure -- Discussion -- Activity and Productivity -- Discussion -- CONCLUSIONS -- Ownership and Chain Affiliation -- Functional Strategies -- Multihospital System Economies -- Potential For Future Success -- ACKNOWLEDGMENTS -- NOTES -- Response to Financial Incentives Among Investor-Owned and Not-For-Profit Hospitals: An Analysis Base ...

SUMMARY OF PRINCIPAL FINDINGS -- DATA BASE AND METHODS -- RESULTS -- General Observations -- Profitability and Growth -- Pricing Strategies -- Operating Expenses -- Patient Selection -- Hospitals that Changed Ownership During the Period -- CONCLUDING STATEMENT -- ACKNOWLEDGMENTS -- Hospital Acquisitions and Their Effects: Florida, 1979-1982 -- RESEARCH DESIGN -- DESCRIPTION OF HOSPITALS THAT CHANGED OWNERSHIP -- ANALYSIS OF PRE-ACQUISITION CHARACTERISTICS -- Profitability -- Types of Patients Treated -- Efficiency of Operations -- Revenues -- Available Resources -- Regional Characteristics -- Overall Characteristics of Hospitals that Subsequently Changed Ownership -- ANALYSIS OF POST-ACQUISITION BEHAVIOR -- Profitability -- Types of Patients Treated -- Efficiency of Operations -- Revenue -- Available Resources -- Overall Changes in the Post-Acquisition Period -- DISCUSSION -- References -- APPENDIX A -- APPENDIX B -- Hospital Ownership and Comparative Hospital Costs -- INTRODUCTION -- DATA -- RESEARCH SAMPLE -- ANALYTIC METHODS -- RESULTS -- Experience per Discharge -- Utilization Rates -- Charges per Discharge -- Margins on Revenue -- DISCUSSION -- NOTES -- References -- APPENDIX -- Medicare Patient Outcomes and Hospital Organizational Mission -- METHODS -- DESCRIPTIVE STATISTICS -- Mortality During The Stay -- Mortality Rates Within 180 Days of Admission -- Readmission Rates Within 90 Days Of Discharge -- Size Of Hospital -- Medicare Case Mix -- Organization Of Hospital -- Accreditation Trends -- STATISTICAL RESULTS -- Mortality During The Stay -- 180-Day Post-Admission Mortality -- 90-Day Readmission Rates -- Accreditation Rates -- Case Mix -- SUMMARY AND DISCUSSION -- Findings on Investor-Owned Hospitals -- Findings on Chain Influences for Investor-Owned Hospitals -- NOTES -- References -- APPENDIX A -- Controlling for Severity.

Specifying Ownership Measures.