Non-profit multi-hospital organizations: challenges and prospects.

This study seeks to determine the relative importance of factors non-profit hospital administrators rely on in their decisions to join a non-profit multihospital organization (MO) and their assessments of an MO in satisfying these motives. A related objective of the study is to determine whether or not the administrators of different types of hospitals (i.e. general vs specialty, member of a national vs non-national MO and church-affiliated vs non-church affiliated) differ in their judgements. The analytical framework of the importance-performance technique is used in analyzing the data gathered from the top administrators of a nation-wide sample of hospitals in the USA. Results and implications of the study are discussed.

System growth a close race. 1997 multi-unit providers survey finds not-for-profits ahead by a nose.

For the first time in five years, the biggest dealmakers in 1996 were not-for-profit systems, not their giant for-profit brethren. But it was a close race, according to this year's Multi-unit Providers Survey. Based on total hospitals, not-for-profits grew 12% vs 11.3% at for-profits. In the psychiatric sector, the number of facilities rose 17%, but the number of deals tumbled 26%. And in the post-acute sector, outpatient and rehab services led the way.

Multi-unit providers survey. A tale of two ownership sectors.

In 1995 investor-owned systems balanced cutbacks and profits, while not-for-profits suffered at the bottom line. Psychiatric hospital systems saw more upheaval, and outpatient and post-acute care grew at a steady pace. And in the senior-living business, the smart money was on assisted living.

The adoption of corporate restructuring by hospitals.

This study investigates factors associated with the adoption of corporate restructuring by hospitals in Massachusetts, where restructuring occurred much more rapidly than it did nationally. Drawing on studies of management innovation in hospitals, this article hypothesizes that early adopters will differ from those that adopt later on the basis of individual and organizational factors, and that institutional forces will explain later adoption. The findings show no differences between early and later adopters but do show that after an intense period of restructuring, hospitals became less likely to adopt the innovation. The article concludes with a discussion of the impact of reimbursement laws on the adoption pattern and the implications for the diffusion of management innovation, particularly under health care reform.

The divergence of federal and state policies on the charitable tax exemption of nonprofit hospitals.

Nonprofit hospitals have traditionally enjoyed charitable exemption from real estate taxes because they provide specific social benefits. However, in the past three decades, major health policy changes at the federal level--most significantly, implementation of the Medicare and Medicaid programs--have weakened this rationale. Federal tax regulations during this period have changed in ways that complement these federal health programs and the accompanying federal interests in encouraging efficiency and performance uniformity among hospitals. States and local governments, however, have different interests, and these may favor a strict set of tax exemption standards that disregard efficiency and elevate the importance of a measurable level of charitable service. Their divergent policies rest on a fundamental value judgment about whether nonprofit hospital care is intrinsically charitable or not. Increasingly, this judgment may be forced upon state courts and legislation by local governments seeking new tax revenues through the elimination of hospitals' exemption from real estate taxes.