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Health Services Utilization and Financial Performance of For-Profit versus Nonprofit Hospitals: A Study of General Acute Care Hospitals in the United States

미국 영리병원과 비영리병원의 의료이용도와 재무성과 비교

  • Choi, Man-Kyu (Department of Healthcare Management, Korea University) ;
  • Lee, Keon-Hyung (Askew School of Public Administration and Policy, Florida State University) ;
  • Lee, Bo-Hye (Graduate School of Healthcare Management, Korea University)
  • 최만규 (고려대학교 보건행정학과) ;
  • 이건형 (플로리다주립대학교 행정정책학과) ;
  • 이보혜 (고려대학교 일반대학원 보건과학과 보건관리학)
  • Published : 2008.12.30

Abstract

As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.

Keywords

References

  1. 감 신. 영리법인 의료기관 설립 허용의 문제점. 예방의학회지 2004;37(2):104-110
  2. 권순만. 미국의 병원정책. 병원경영학회지 1998;3(1):238-260
  3. 권순만.재무성과와 병원산업의 동태적 변화:퇴출과 법적소유형태의 전환. 정책분석평가학회보 1999;9(1):37-51
  4. 이윤석, 유승흠. 병원의 수익성 관련 요인. 보건행정학회지 2003;13(3):129-147
  5. 이해종. 영리법인의 의료기관 설립허용에 대한 의견. 예방의학회지 2004;37(2):99-103
  6. 이해종 외.재원일별 진료비 변화 및 재원일수 단축의 의료수입 증대효과 분석.병원경영학회지. 1998;3(1):100-120
  7. 정영호, 고숙자. 비영리병원과 영리병원의 성과차이 분석: 미국을 중심으로. 보건복지포럼 2005;109:65-75
  8. 최만규, 문옥륜, 황인경. 병원의 재무구조에 영향을 미치는 요인. 보건행정학회지 2002;12(2):43-75
  9. 최만규 외. 병원회계학(5판). 보문각 2008:47-51
  10. 한국보건산업진흥원. 병원경영분석 2001
  11. 황인경. 병원의 수익성 관리개선을 위한 의료이익계획모형 및 혁신.합리화전략개발 연구. 병원경영학회지 1996;1(1):88-91
  12. Choi MK, Lee KH. A Strategy for Enhancing Financial Performance: A Study of General Acute Care Hospitals in South Korea. The Health Care Manager 2008;27(4):288-297 https://doi.org/10.1097/HCM.0b013e31818c806e
  13. Cleverley WO. Improving financial performance: a study of 50 hospitals. Hospital and Health Services Administration 1990;35(2):173-187
  14. Dawson S. "Health Care Consumption and Consumer Social Class: A Different Look at the Patient". Journal of Health Care Marketing 1989;9(3):15-25
  15. Enthoven AC, Tollen LA. Competition in Health Care: It Takes Systems to Pursue Quality and Efficiency. Health Affairs 2005;10.1377/hlthaff.w5.420
  16. Forgione DA, Schiff AD, Crumbley DL. Assessing Hospital Performance: An Inventory of Financial and Nonfinancial Metrics, International Association of Management J, Forum on Research in Healthcare Financial Management 1996;8,2:65-83
  17. Gapenski LC, Vogel WB, Langland-Orban B. The determinants of hospital profitability. Hospital and Health Services Administration 1993;38(1):63-80
  18. Gray BH. Conversion of HMOs and hospitals: What's at stake? Health Affairs 1997;16(2):29-47 https://doi.org/10.1377/hlthaff.16.2.29
  19. Griffith J, White K. The well managed healthcare organization, $6^{th}$ edition. Health Administration Press, Chicago, IL, 2006
  20. Hartz AJ, Krakauer H, Kuhn EM, et al. "Hospital characteristics and mortality rates". New England Journal of Medicine 1989,321:1720-1725 https://doi.org/10.1056/NEJM198912213212506
  21. Hassan MG, Wedig, Morrisey M. Conditional Tax Exemption and the Output of Nonprofit Organizations: The Case of Hospital Charity Care, mimeo, University of Pennsylvania, 1995
  22. Herzlinger RE, Krasker WS. "Who profit form nonprofits?". Harvard Business Review 1987(January/February);93-106
  23. Hofmarcher MM, Paterson I, Riedel M. Measuring hospital efficiency in Austria-a DEA approach. Health Care Management Science 2002;5(1):7-14 https://doi.org/10.1023/A:1013292801100
  24. Keeler EB, Rubinstein LV, Kahn KL, Draper DL, Harrison ER, McGinty MJ, Rogers WH, Brook RH. "Hospital characteristics and quality of care". Journal of the American Medical Association 1992;268(13):1709-1714 https://doi.org/10.1001/jama.268.13.1709
  25. Keeler EB, Melnick GA, Zwanziger J. The Changing Effects of Competition on Non-Profit and For-Profit Hospital Pricing Behavior. Journal of Health Economics, 1999, 18(1):69-86 https://doi.org/10.1016/S0167-6296(98)00036-8
  26. Kongstvedt PR. Essentials of Managed Health Care, 5th ed. Aspen Publication, Gaithersburg, MD. 2007
  27. Lee KH, Yang SB, Choi MK. The Association between Hospital Ownership and Technical Efficiency in a Managed Care Environment. Journal of Medical Systems 2008 July; Published Online(http://www.springerlink.com/content/4184482638607241)
  28. Mark TL. "Psychiatric hospital ownership and performance". Journal of Human Resources 1996;1(3):631-649
  29. Mark TL. Analysis of the Rationale for, and Consequences of, Nonprofit and For-Profit Ownership Conversions. Health Services Research 1999;34:83-101
  30. Ozcan YA, Luke RD, Haksever C. Ownership and organizational performance: a comparison of technical efficiency across hospital types. Medical Care 1992;30(9):781-94 https://doi.org/10.1097/00005650-199209000-00003
  31. Ozcan YA, McCue MJ, Okasha AA. Measuring the technical efficiency of psychiatric hospitals. Journal of Medical Systems 1996;20(3):141-50 https://doi.org/10.1007/BF02281992
  32. Pallarito K. Shaping hospitals capital spending decisions. Modern Healthcare 1990;20(16): 33-40
  33. Picone AG, Chou S, Sloan FA. Are For-Profit Hospital Conversions Harmful to Patients and to Medicare? Rand Journal of Economics 2002;33(3):507-523 https://doi.org/10.2307/3087470
  34. Relman A. The New Medical-Industrial Complex. New England Journal of Medicine 303 1980;963-70 https://doi.org/10.1056/NEJM198010233031703
  35. Renn SC, Schramm M, Watt, Derzon R. The Effects of Ownership and System Affiliation on the Economic Performance of Hospitals. Inquiry 22 1985;219-36
  36. Sear AM. Operating Characteristics and Comparative Performance of Investor-Owned Multihospital Systems. Hospital and Health Services Administration 1992;37,3:403-415
  37. Shen YC. "Changes in Hospital Performance After Ownership Conversions". Inquiry 2003; 40:217-234
  38. Shortell SM, Kaluzny AD. Health Care Management: Organization Design and Behavior (5th). Thomson Delmar Learning 2006:14
  39. Sloan FA, Picone AG, Taylor DH, Chou S. Hospital Ownership and Cost and Quality of Care: Is There a Dime's Worth of Difference? Journal of Health Economics 2001;20(1):1-21 https://doi.org/10.1016/S0167-6296(00)00066-7
  40. Thorpe KC, Florence CS, Seiber EE. Hospital Conversions, Margins, and Provision of Uncompensated Care. Health Affairs 2000;19(6):187-194 https://doi.org/10.1377/hlthaff.19.6.187
  41. Valvona J, Sloan FA. Hospital profitability and capital structure: a comparative analysis. Health Services Research August 1988;23(3):343-357
  42. Vogel WB, Orban BL, Gapenski LC. Factors influencing high and low profitability among hospitals. Health Care Management Review 1993;18(2):15-26 https://doi.org/10.1097/00004010-199321000-00003
  43. Walker C. A Cross-Sectional Analysis of Hospital Profitability. J of Hospital Marketing 1993;7,2:121-138 https://doi.org/10.1300/J043v07n02_11
  44. Wan TTH, Lin YJ, Ma A. Integration mechanisms and hospital efficiency in integrated healthcare delivery systems. Journal of Medical Systems 2002;26(2):127-43 https://doi.org/10.1023/A:1014805909707
  45. Younis M, Forgione DA, Khan M, Darkoulas J. Hospital Profitability in Florida: A Revisitation, Research in Healthcare Financial Management 2003;8,1:95-102
  46. Younis MZ, Forgione DA. Using return on equity and total profit margin to evaluate hospital performance in the U.S.: a piecewise regression analysis. J Health Care Finance 2005 Spring;31(3);82-88
  47. Zwanziger J, Melnick GA. The Effects of Hospital Competition and Medicare PPS Program on Hospital Cost Behavior in California. Journal of Health Economics, 1988, 7(4):301-320 https://doi.org/10.1016/0167-6296(88)90018-5
  48. Zwanziger J, Melnick GA, Bamezai A. The Effect of Selective Contracting on Hospital Costs and Revenues. Health Services Research, 2000, 35(4):849-867