Profit Versus Not-for-Profit
Hospitals
In Partial Fulfillment of the Requirements for
Health Services Systems
HSM 541
Blaise X. Schmidt
DeVry University
Keller Graduate School of Management
September 2012
1.0 Purpose
The purpose of this paper is to conduct a comparative analysis between for-profit hospitals and not-for-profit hospital. It will discuss the characteristics of each as well as factors affecting the operations of both systems. Additionally, it discusses potential areas of improvement and some of the challenges associated with each relative to finance and operations.
2.0 Comparing Not-for-Profit and For-Profit Hospitals
Not-for-profit hospitals are organized under the Section 501 (c)(3)
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It is also possible that a nonprofit hospital, especially in a large city, may be busier at any given time than a for-profit hospital. To get an idea of what a large city’s nonprofit hospital is like, you can recall the television show “ER,” which was set in a nonprofit hospital. By treating everyone regardless of ability to pay, nonprofits provide a needed service (Writing, 2012). The IRS interprets this reasoning in their rulings.
Another term often used with both not-for-profit and for-profit hospitals is uncompensated hospital care. With not-for-profit and for-profit, revenues come from daily operations. What happens if a person cannot afford the care in a not-for-profit hospital? Regardless of the type operation, hospitals must stabilize the patient and transport to a public hospital, even though they are not required to treat these patients. This uncompensated care is classified as uncompensated care, bad debt, or charity care. For-profit hospitals write off this bad debt and use these figures to offset their profits and to assist in developing their costs to Medicare and Medicaid programs.
Public not-for-profit hospitals are dependent upon tax-based support for their government sponsors and from patient revenues. Capital budgeting can be financed through government bonds that must be voted upon during elections. Under these circumstances, it is difficult to maintain current equipment and capital
In 1997 University of California, San Francisco (UCSF) merged its two public hospitals with Stanford’s two private hospitals. The two separate entities merged together to create a not-for-profit organization titled UCSF Stanford Health Care. The merger between the health systems at UCSF and Stanford seemed like a good idea due to the similar missions, proximity of institutions, increased financial pressure with cutbacks in Medicare reimbursements followed by a dramatic increase in managed care organizations. The first year UCSF Stanford Health Care produced a profit of $22 million, however three years later the health system had lost a total of $176 million (“UCSF-Stanford Merger,” n.d.). The first part of this paper will address reasons
Nonprofit hospitals have become a common characteristic of the hospital sector because they can be found across the country because of their presence in almost every corner, they never decline to provide treatment, and offer several community-based health programs. On the contrary, the for-profit health facilities are regarded as the corporate model of health care services as they seek to make profit first. They enjoy huge capital that enables them to develop state-of-the-art facilities and purchase the latest clinical technologies.
The role of finance in Health Care Systems, Inc. as a regional not-for-profit hospital relates to both the accounting and financial management aspects of the business. Facets of both accounting and financial management are intertwined with maximizing productivity by way of managing and analyzing financial operations to ensure resources are being utilized properly (Gapensiki, 2013). The divulgence of financial reports to managers and investors will aid in the development of plans and budgets for future growth, assess acceptable levels of financial risk, manage contracts appropriately and make decisions related to capital investments allowing the organization to expand service offerings thereby demonstrating greater value in the community. Operating as a not-for-profit entity requires that the hospital operate exclusively in the interest of the public for a charitable purpose. Through understanding who the primary third party payers
As discussed previously, the Affordable Care Act of 2010 passed by the legislature, drastically changed the entire healthcare economy. In fact, ever since the ACA was passed it was required by law for hospitals to increase the amount of attention given to the individuals of the community in order to meet their needs. Also, the ACA allowed close to 10 million individuals to have health insurance through Medicaid and private health insurances, which has a high impact on all the hospitals, such as Yale New Haven. For example, since millions of Americans can now afford health insurance, there is a large influx of patients who can go to hospitals and actually afford the overall cost. The non-profit hospital of Yale New Haven is benefiting in two ways. First, they are achieving their mission by caring for the individuals of their community who now have insurance and secondly, they are being compensated in terms of revenue to improve their organization in regards to hiring the greatest physicians and having the best technology and supplies to treat their large influx of patients (Cunningham, 2015). The rise in health insurances increases the total amount of money earned by that non-profit organization and the amount of patients receiving great quality of care.
The Non-profit hospitals were established for charitable purposes and tend to be larger, and are more likely to be teaching hospitals. They also are responsible and accountable to the communities they serve. They are governed by leaders of the communities they serve. Earnings received from the non-profit hospitals are reinvested to improve quality and care provided at the hospitals, and also invested in community programs, such as providing no fee or discounted fees to the uninsured and low income for health care services. Non-Profit healthcare organizations mission is to serve communities by providing healthcare without regard for a
The debate over non-profit versus for-profit healthcare organization has been ongoing, does one provide better care than the other? Do the operations of for profit perform better than the non-profit organizations? Are the criticisms about for-profit organization validated and is there proof? The goal is to examine those questions as well as offer options to improve the financial and operational performance of non-profit and for-profit organizations criticisms.
Next, we studied the financial structures of health care organizations. Specifically, we examined the structure of nonprofit healthcare organizations. I remember spending a good amount of time debating whether or not nonprofits should maintain their tax exempt status. As someone who had spent their entire professional career working for a nonprofit organization, I often viewed myself as the sole champion for these organizations. In sessions and on the discussion boards, I advocated that nonprofit healthcare organizations in most situation function as a safe net of the community and that the level of community benefits these organizations provide do justify the lost revenue for state and federal agencies.
To add to the dilemma, the rising cost of healthcare will not adequately be addressed by any new healthcare system. The costs of healthcare in America are staggering and currently represent over 17% of our national GDP with the expectation of that number rising to 20% in less than 5 years. These costs are direct hits on the revenues received by hospital which affect their ability to remain operational. As the hospital’s revenues and profit margin decrease, so does the expected longevity of the hospital.
The expanded health insurance coverage via the Affordable Care act is having a major effect on managed care hospitals in many avenues. These effects are impacted via the increase in demand for care, the increase of patient revenues, as well as a lower uncompensated care especially for the uninsured. Not surprisingly, the constraints as well as the controls that are being imposed by the managed care have lead to an outrage by the doctors and their patients. Managed care in the United States finds itself under attack from every side. As far as the managed care organizations are concerned, administrators are unease regarding the profitability or the surplus for reinvestment and even the consumers are also worried about the possible closure of hospitals (Goodson, 2010). Managed Care Organizations have been forced to reduce hospital utilization even though there have also been a few facility closures.
The debate on whether all healthcare institution should be non-profit rises many issues and they have been heavily debated. The best way to examine this to analyze if non-profit hospitals are in fact better that for
Hospitals are a local monopoly. The result is that hospitals may tend to monopolize their local area, consolidating or driving competitors out of business and then charging rent-extracting prices for their services. Given the basic necessity of healthcare services and the resulting political sensitivity of the issue, this is generally viewed as a Bad Thing. So government serves a role by treating hospitals like an airport,
The intention of this research paper is to further understand the financial statement of four distinct hospitals located in the San Diego, California County. An analysis of the financial report for Sharp HealthCare, Scripps Health, Tri-City HealthCare, and Palomar Health will be briefly discussed individually on each important financial outcome’s Such as: assets, liabilities, revenue, expenses, hospital debt, and investments. To analyze further, a break down between the hospitals assets, liabilities, and revenue will be compared in the paper.
Though they are not entirely comprehensive tools, a great deal can be learned about a hospital or other healthcare organization for-profit or not-for-profit from an examination of their annual financial documents (Finkler & Ward, 2006). The balance sheet and statement of revenue and expense can both yield valuable clues even in the absence of other evidence about changes that might be occurring in the organization, a definition of the type and degree of certain problems that it might be facing, and potential opportunities for improvement in performance that might exist (Finkler & Ward, 2006). Comparing two or more years' worth of financial information yields even more valuable insights, tracking movement in the hospital or other organization's ability to finance its activities and thus continue providing services at the same level, quantity, and scope as current operation.
“Hospitals can be non-profit, for-profit, and government-owned and/or operated” (Baker & Baker, 2006). There are different terms for each classification in how to report and handle the finances but the basics are the same for any type of business. Business finances require the following basic fundamentals: creating “budgets, understanding capital expenditure, loan acquisition, and financial fees” (Baker & Baker, 2006). Government owned and operated hospitals offer unprofitable services; which
The hospital industry consist of privately and publicly owned and operated hospitals and medical facilities. The financial backgrounds of these assorted categories of organizations are sizeable and contrasted. Therefore, industry ratios are to be considered and evaluated from a greater proportion in order to identify with the financial data involving the industry as a whole (Dunn & Becker, 2013). Based on analysis and evaluation of the financial ratios gained from Nasdaq and Google Finance, it is apparent that the hospital industry is gradually rising and supports increase in profitability. These ratios are divided into several categories: Growth rates, financial strength, valuation, profitability, efficiency, dividends, and management effectiveness.