Nonprofit and for-profit home care in Israel: clients' assessments

Clients' assessments of differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly were studied. No significant differences were found between nonprofit and for-profit providers with respect to organizational efficiency; speed of placement and replacement of home care workers; responsiveness to clients' complaints; and supervision of care plans, schedules, and service delivery. Systematic differences were found, however, in clients' perceptions of workers employed by nonprofit versus for-profit service providers. The differences related to the home care workers' adaptation to clients' needs and wants; how well workers delivered services; and how satisfied clients were with the services received. Indications are that the relatively high efficiency of nonprofit organizations can largely be attributed to the performance of their home care workers.     

Nonprofit and For-Profit Home Care in Israel

Clients' assessments of differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly were studied. No significant differences were found between nonprofit and for-profit providers with respect to organizational efficiency; speed of placement and replacement of home care workers; responsiveness to clients' complaints; and supervision of care plans, schedules, and service delivery. Systematic differences were found, however, in clients' perceptions of workers employed by nonprofit versus for-profit service providers. The differences related to the home care workers' adaptation to clients' needs and wants; how well workers delivered services; and how satisfied clients were with the services received. Indications are that the relatively high efficiency of nonprofit organizations can largely be attributed to the performance of their home care workers.     

A Focus on the Program of All-Inclusive Care for the Elderly (PACE)

For over four decades, the Program of All-Inclusive Care for the Elderly (PACE) has been operated by nonprofit organizations. Research has demonstrated that nonprofit PACE provides quality, cost-effective community-based care to older adults who would otherwise require a nursing home level of care. Recently, the U.S. Secretary of the Department of Health and Human Services has authorized for-profit entities to operate PACE, contingent on their ability to demonstrate that they can provide care that is similar to nonprofit PACE with regard to access to care, quality of care, and cost-effectiveness. In 2013, a study was conducted to evaluate how PACE operates under for-profit versus nonprofit status. The results were presented to Congress which, in turn, authorized for-profit PACE providers. This article critiques the 2013 study, offers a comparison to for-profit hospice, and argues that at best there is not enough evidence to conclude that for-profit PACE provides the same quality of care as existing nonprofit operators.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Why nonprofit nursing homes pay higher nurses' salaries

It is generally agreed that nonprofit nursing homes pay higher wages to their employees, hire more staff per patient, and are thus more costly than for-profit nursing homes. We attempt to show that higher costs in nonprofit nursing homes are related to higher quality of care in these homes. Using the 1985 National Nursing Home Survey, we show that nurses in nonprofit nursing homes have different characteristics than nurses in for-profit homes and that these differences in characteristics account for the differences in wages, a finding consistent with our hypothesis concerning quality differences between types of homes.     

Management implications of government funding of nonprofit organizations: Views from the United States and Canada

Most American authors approach nonprofit institutions as an alternative to both for-profit and public provision. This view suggests that the issues surrounding governance focus on the tension between the needs of individuals who finance or benefit from the activities of nonprofits and the goals of those who manage them. A different paradigm is more appropriate in much of the rest of the world. This article focuses on Canada, where the decision to use nonprofit organizations is made largely by governments. Examples from the Canadian experience with health care, higher education, day care, and television illustrate this difference and some of the implications for nonprofit management that follow from it.     

Changing Relationships Between Nonprofit and For-profit Human Service Organizations Under the Long-Term Care System in Japan

In Japan, a nonprofit organization system enacted in the late 1990s and the later introduction of privatization policies in human services were expected to overturn government dominance of nonprofit organization activities. By focusing on the long-term care insurance (LTCI) system, which privatized public human services for the first time in the country, this study empirically examines whether, and to what extent, nonprofit–government relationships in Japan have actually changed as a result of this new system. In addition, because LTCI newly allows for-profit organizations to provide services, the influence of such organizations were incorporated into the analysis. The outcomes of this study demonstrate that the government continues to extend its sphere of influence over nonprofit and for-profit organizations through LTCI. In addition, for-profit organizations appear to be more successful than nonprofit organizations, in that the former organizations have overcome their lack of experience as public service providers by taking over the roles that nonprofit organizations have traditionally occupied.     

ANTITRUST TREATMENT OF NONPROFITS: SHOULD HOSPITALS RECEIVE SPECIAL CARE?

Nonprofit hospitals receive favorable tax treatment in exchange for providing socially beneficial activities. Extending this rationale suggests that nonprofit hospital mergers should be evaluated differently than mergers of for-profit hospitals because suppression of competition may also allow nonprofits to cross-subsidize care for the poor. Using detailed California data, we find no evidence that nonprofit hospitals are more likely than for-profit hospitals to provide more charity care or offer unprofitable services in response to an increase in market power. Therefore, we find no empirical justification for applying, as some courts have suggested, different antitrust standards for nonprofit hospitals. (JEL I11, L1, L44)     

Innovation,Professional Interests,and Nonprofit Organizations: The Case of Health Care in Poland

Nonprofit organizations have a role in spreading technological innovation. The experience in Poland illustrates that entrepreneurial health care professionals prefer nonprofit organizations over for-profit organizations to introduce novel services to the market because nonprofits create favorable public perceptions of those services.     

DO NONPROFIT AND GOVERNMENT NURSING HOMES ENTER UNPROFITABLE MARKETS?

Using data from markets in the rural United States, this study addresses whether nonprofit and government nursing facilities locate in markets that for-profit firms cannot profitably enter, thereby expanding access to nursing care to populations that would not otherwise be served. The results indicate that while nonprofit and for-profit nursing homes typically enter similar markets, government nursing homes are more likely to enter markets that have small populations generally and too few elderly residents to be profitable for for-profits. The results have implications for the efficient provision of access to long-term care for isolated populations and other underserved groups. (JEL L10, L20, I11)     

Should St. Merciful Hospital Become CorpHealth,Inc.?: Ownership and Quality in U.S. Health Care Organizations

In this article, a review of empirical research on ownership and quality of care suggests the existence of a quality gap between for‐profit and nonprofit firms in some health sectors, depending on the prevailing type of financial payment for health care. Results of a theoretical model incorporating quality of care suggest that the nondistribution constraint is a simple and powerful explanation for a higher level of patient care quality at nonprofit health care facilities when reimbursement for health services is fixed prospectively. Analysis suggests that review of future conversions of health care facilities from nonprofit to for‐profit status should take into consideration the implied effects of the conversion on patient outcomes.     

The impact of ownership form and regulatory measures on firm behavior: a study of hospices

This article examines differential responses to the Medicare hospice benefit across ownership types. The analysis reveals little difference in costs or quality of service among government-owned, for-profit, and nonprofit hospices. However, there are significant differences in the numbers of patients served by ownership status. The results are consistent with the hypothesis that nonprofit hospices are patient maximizers, not profit maximizers in disguise who are aiming to circumvent the nondistribution constraint. A comparison of these results with those in the hospital and nursing home industries leads to the conclusion that Medicare regulations and the predominance of Medicare revenues in an industry induce similar outcomes in cost and quality across ownership types.     

An Ethnography of an AIDS Hospice: Toward a Theory of Organizational Pastiche

This article describes everyday life at a hospice that provides terminal, residential care to persons with AIDS. Data were gathered over 12 months of participant observation and a series of formal interviews. The hospice is a nonprofit organization that receives most of its financial support from local community churches and agencies. The philosophy of the hospice is common to its genre—that is, care for dying patients should be holistic, personal, and palliative. The hospice staff largely adheres to this philosophy yet also organizes its everyday activities to meet the practical needs of everyone involved. Some of the more interesting staff practices include the use of touch for healing and communicating, and stress management techniques. The essence of everyday life in the hospice, though, is the relationship between the staff member and the resident. The study identifies three types of relationships—caring, pastoral, and intimate. The conclusion focuses on the value of integrating traditional interactionist ethnography and postmodernist social theory for conducting qualitative research on emerging health care phenomena like the AIDS hospice. The concept of organizational pastiche is offered to interpret the distinctive ways health care organizations specializing in HIV/AIDS care must adapt to the unprecedented cultural and biological features of the epidemic.     

THE NONPROFIT FIRM: A POTENTIAL SOLUTION TO INHERENT MARKET FAILURES

This article analyzes the differences in products offered by nonprofit and for-profit firms in a monopolistically competitive industry where goods are differentiated both by product attributes and by the degree to which benefits are public. Because nonprofit firms receive donations, they provide a Pareto improvement of the equilibrium product set: nonprofit firms will be less biased against goods with a high social good component than will their for-profit counterparts, hi addition, the optimal donations function which equates the nonprofit equilibrium product set to the set which maximizes societal welfare is derived.     

The need for policy direction in the provision of care to the mentally ill: an interdisciplinary view

This paper argues that mental health care is underprovided, and that the role of nonprofit providers should be expanded for three major reasons. First, a positive externality exists since society, as a whole, benefits when those in need of mental health care consume care. External benefits include lower crime rates, lower unemployment, and less homelessness. Second, consumers of mental health care are mentally ill and often do not believe that they need care, underestimate their need, or believe that care is not worth the time or expense. Third, common law, to a large extent, is based on individual liberty, largely ignoring the benefits individuals receive from treatment. It is argued that government policy is needed to increase the supply of mental health care, through nonprofit agencies.     

Does Public or Not-for-Profit Status Affect the Earnings of Hospital Workers?

This paper examines the earnings differentials among hospital workers in the public, private nonprofit, and private for-profit sectors. Utilizing data from the 1995 through 2007 Current Population Surveys, unadjusted earnings are highest in the private nonprofit sector and lowest in private for-profit firms. Once measurable characteristics are accounted for, health practitioners in for-profit and nonprofit hospitals earn similar wages while public sector workers earn small but significant wage penalties. Nonprofit hospitals tend to attract workers with higher levels of skill as measured by schooling and potential experience. This could be explained in part by worker sorting and lower cost containment incentives in nonprofit hospitals. Wage change analysis using pooled 2-year panels constructed from the CPS indicate no significant differences in earnings between the three sectors of employment. Whatever the role of the sector of employment on the overall earnings of hospital workers, there is sufficient worker mobility within the industry to largely eliminate systematic wage differences across type of hospital.

From tragedy to triumph: a segue to community building for children and families

In 2000, more than 60 nonprofit agencies, health care providers, government officials, and community advocates in Tarrant County, Texas, came together to work for systemic change in the mental health care system. The coalition, known as the Mental Health Connection, began working toward a "No Wrong Door" approach to mental health services, which required aggressive coordination between federal, private, and nonprofit resources. The result is a five- to six-year plan for implementation of a new systems of care model for children with severe emotional disturbances and their families. The Mental Health Connection also focuses on legislative advocacy to bring about necessary policy changes at the local, state, and federal levels. Finally, the coalition focuses on developing sustainable revenue streams that will allow the new systems to remain in place once the group accomplishes the initial mission of the Mental Health Connection.     

Competing for tots: operating objectives and characteristics of for-profit and not-for-profit child care centres in the Pacific Northwest

Child care services are provided by profit-oriented businesses, not-forprofit agencies and governmental units. This paper compares goal priorities and operating characteristics of not-for-profit and for-profit child care centres in parts of Canada and the United States. Directors of 292 Pacific Northwest centres responded to a survey about their financial and non-financial operating objectives. The relative rankings of objectives were similar for not-for-profit and for-profit centres, and for centres in both countries. Non-financial objectives were rated higher than financial objectives. Satisfying the developmental and educational needs of children was the single most important operating objective. Providing access to eligible children was the next most important objective, particularly for not-for-profit centres and for those with government-subsidised children. The remaining objectives, in order of importance, were minimising costs, maximising utilisation, maximising revenues and maximising profits. Profit maximisation was ranked low by both not-for-profit and for-profit respondents. Not-for-profit and for-profit centres exhibited differences on a number of operating characteristics, services provided and employee benefits. Such characteristics were found to be associated with auspices (not-for-profit or for-profit) and location (US or Canada). Results suggest that centres operating under both auspices are capable of altruistic behaviour. Differences in motivation between organisational forms were very small. However, variations in operating characteristics and services suggest that the objectives are achieved in dissimilar ways.     

Nursing home ownership: an historical analysis

The need to care for dependent elderly in the United States has been a constant since colonial times. Today, as in the earliest days, most care is provided at home by family members. Personal and health services outside the home are sometimes provided by nursing homes. The nursing home industry is large, dominated by private, for-profit ownership, and receives much of its income from public funds. Why are nursing homes publicly funded? Why are nursing homes privately rather than publicly owned? Why is ownership for-profit or proprietary rather than not-for-profit or voluntary? The answers to these questions are found in the history of social policies in the United States.     

The growth of the nonprofit sector in the 1980s: Facts and interpretation

The nonprofit sector was the growth sector of the 1980s. This is the conclusion reached from detailed examination of the growth trends of major industry groups in New York State in the years 1981 through 1987. The analysis in this article suggests that the growth of the nonprofit sector was due primarily to the strong orientation of the economy toward services, where the nonprofit sector has traditionally had an important presence. Within service industries as a whole, the nonprofit and for-profit sectors grew at comparable rates; however, nonprofit growth was concentrated in semipublic services and in services where information is often difficult for consumers to acquire and understand, while the for-profit sector grew in simpler and more privately oriented services. The analysis shows that the nonprofit sector filled much of the gap left by reduced or stagnating government services. However, the growth of the nonprofit sector may be difficult to sustain in the future if sufficient entrepreneurial talent and other resources are not forthcoming.