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Author(s):  
Amanda Beck ◽  
Collin Gilstrap ◽  
Jordan Rippy ◽  
Brian Vansant

AbstractIn this paper, we examine bad debt and charity care reporting by nonprofit hospitals around bond issuance. Given the tax advantages afforded to nonprofit hospitals, including the ability to issue tax-exempt debt, hospital managers encounter stakeholder pressure to provide community benefits. When nonprofits issue debt, they also face economic pressure to meet creditors’ financial performance expectations. We document a reporting strategy that allows nonprofit hospitals to reduce the cost of bond debt while simultaneously alleviating regulators’ and community members’ concerns about inadequate provision of charity care. Using data from public bond issues for California nonprofit hospitals, we find that hospital managers shift costs from bad debt expense to charity care in periods prior to a public bond issuance and that the strategy is associated with a lower cost of debt. Our results inform those relying on accounting measurements to infer nonprofit hospitals’ social good provisions and financial health.


2021 ◽  
pp. 107755872110396
Author(s):  
Ge Bai ◽  
Hossein Zare ◽  
Matthew D. Eisenberg ◽  
Daniel Polsky ◽  
Gerard F. Anderson

Nonprofit hospitals provide charity care to financially disadvantaged patients according to their self-designed eligibility policies. The Affordable Care Act may have prompted nonprofit hospitals to adopt more generous eligibility policies, but no prior research has examined the longitudinal trend. The expansion of Medicaid coverage in many states has been found to reduce charity care provision, but it is unclear whether the change in charity care eligibility policies differed between Medicaid expansion and nonexpansion states. Using mandatory tax filings, we found that both hospitals in Medicaid expansion states and hospital in nonexpansion states adopted more generous eligibility policies in 2018 than in 2010, but the change was greater in the former for discounted charity care; while the former provided less charity care regardless of their policy changes, the latter provided more when their policies became more generous. This study has implications for policy discussions on the justification of nonprofit hospitals’ tax-exempt status.


Author(s):  
Philippe Choné ◽  
Lionel Wilner

Abstract In the late 2000s, a regulatory reform dramatically strengthened the incentives of French nonprofit hospitals to attract patients. Exploiting exhaustive data for surgery treatments between 2005 and 2008, and modeling hospitals as supplying utility to patients, we show that increased competitive pressure on nonprofit hospitals caused them to perform more procedures, but did not inflate overall activity at the industry level. Although they have gained market shares over their for-profit counterparts, nonprofit hospitals have been significantly worse off after the reform. To adjust to stronger financial incentives, they incurred an additional effort (pecuniary and non-pecuniary costs) equivalent to about a quarter of their annual revenue.


2021 ◽  
Vol 24 ◽  
pp. S181-S182
Author(s):  
A. Vidal Filho ◽  
Y. Silva ◽  
L. Tôrres ◽  
C. Abicalaffe ◽  
L. Ribas ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenbin Zang ◽  
Mei Zhou ◽  
Shaoyang Zhao

Abstract Background Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals. Methods Using the claim data of insured inpatients residing in a major Chinese city for the period 2010–2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals. Results The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases. Conclusions Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well.


2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Rui Wang ◽  
Khaldoun AbouAssi

Abstract The 2010 Affordable Care Act expanded Medicaid eligibility to states’ residents with incomes below the federal poverty line, creating both opportunities and challenges to hospitals in states that adopted the new Medicaid eligibility. This article explores the effect of Medicaid expansions on nonprofit hospitals. Using data from Internal Revenue Service and a difference-in-differences design, this article examines the impact of the expansions on the number of, contributions to, and profitability of nonprofit hospitals. The results suggest that Medicaid expansions did not affect the number and profitability of nonprofit hospitals; however, the expansions were associated with a reduction in contributions to certain types of hospitals by around 23%. Therefore, the effects of policy changes vary by the type of nonprofit hospitals, which then need to find better strategies to cope with these changes.


2021 ◽  
Vol 40 (4) ◽  
pp. 629-636
Author(s):  
Ge Bai ◽  
Hossein Zare ◽  
Matthew D. Eisenberg ◽  
Daniel Polsky ◽  
Gerard F. Anderson

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