Determinants of Charitable Donations to Large U.S. Higher Education,Hospital, and Scientific Research NPOs: New Evidence from Panel Data

We provide improved evidence on effects that fund-raising, government support, and program revenue of U.S. higher education, hospital, and scientific research nonprofit organizations (NPOs) have on donations to those NPOs and provide improved estimates of price elasticities of donations to, and donor demand for output of, those NPOs. Applying econometric tests, we find the best-specified model is two-way fixed effects, which controls for organization-specific and time-specific factors. Results suggest that U.S. higher education, hospital, and scientific research NPOs fund-raise to the point where the marginal fund-raising dollar brings in zero dollars of donations, donor demand for output of hospitals and scientific research NPOs is price inelastic and price elastic, respectively, and results are not sensitive to specification of price.     

The Hospital Foundation Strategy and Performance Relationship

Attracting philanthropic donations is a strategic imperative for many hospitals. A hospital can manage the giving process most effectively by developing a well‐managed hospital foundation. This study examines the hospital foundation strategy and performance relationship. Using a sample of 258 hospital foundations we identified different strategies and significant performance differences among them.     

A study of combustibility of wastes of two hospitals for determining disposal by incineration

Determination of quantity, quality and characteristics of the wastes of two hospitals located in the same sector of a class B city was undertaken to review the present dumping method of disposal. On an average 1,424.71 and 224.6 kgs. of five types of wastes as per the moisture content were found daily for seven days in these two hospitals of 1000 general beds, and 600 long stay beds for chest tuberculosis and other Cardiothoracic diseases respectively. The wastes of first hospital had higher combustibility due to its sprawling nature and activities for general patients than that of the second multistoreyed hospital treating special cases. A combustibility analysis of hospital wastes would help to decide whether to adopt incineration for disposal.     

大城市高学历流动人口基本特征调查——以广州市五山街为例

高学历流动人口是促进城市现代化发展重要力量。通过对广州市天河区五山街专科以上学历流动人口调查表明,大城市高学历流动人口快速增长,存在以男性为主、女性比例上升,中青年占主体,居住处所类型以出租屋和单位宿舍为主,职业以企事业单位职员为主,失业率较高等特征。基于此,提出优先开发高学历流动人口,提升城市人力资源优势等建议。     

Nonprofit competition in the grants marketplace

In this study, we test the impact of nonprofit financial health and financial efficiency ratios on the grant amount awarded by foundations using the Georgia grants marketplace as a case. Using hierarchical linear modeling analysis, we can understand the effects of these ratios both within and across foundation grant portfolios. We found statistically significant evidence that grantees with higher debt ratios and higher fundraising ratios receive lower grant amounts. We did not find statistically significant impacts for administrative ratios, revenue diversification, and surplus margin.     

Games of capacity allocation in many-to-one matching with an aftermarket

In this paper, we study many-to-one matching (hospital–intern markets) with an aftermarket. We first show that every stable matching system is manipulable via aftermarket. We then analyze the Nash equilibria of capacity allocation games, in which preferences of hospitals and interns are common knowledge and every hospital determines a quota for the regular market given its total capacity for the two matching periods. Under the intern-optimal stable matching system, we show that a pure-strategy Nash equilibrium may not exist. Common preferences for hospitals ensure the existence of equilibrium in weakly dominant strategies whereas unlike in games of capacity manipulation strong monotonicity of population is not a sufficient restriction on preferences to avoid the non-existence problem. Besides, in games of capacity allocation, it is not true either that every hospital weakly prefers a mixed-strategy Nash equilibrium to any larger regular market quota profiles.     

Israel's long-term care insurance law after a decade of implementation

Israel's Long-Term Care Insurance (LTCI) law has been in effect for a decade. It is timely to review the effects of this legislation with a view to identifying possible directions for reform and lessons for other countries considering the introduction of a similar social insurance scheme. The paper considers the law's effects in terms of the size and characteristics of the beneficiary population, the coverage of the scheme, its financial standing, the rate of institutionalization of the elderly, the caregiving burden, the service delivery system, and the overall scope of long-term care services for the aged. Israel's experience has lessons for financing arrangements, target efficiency, service delivery arrangements, and the construction of the burden of care.     

The embeddedness of organizational performance: Multiple Membership Multiple Classification Models for the analysis of multilevel networks

We present a Multiple Membership Multiple Classification (MMMC) model for analysing variation in the performance of organizational sub-units embedded in a multilevel network. The model postulates that the performance of organizational sub-units varies across network levels defined in terms of: (i) direct relations between organizational sub-units; (ii) relations between organizations containing the sub-units, and (iii) cross-level relations between sub-units and organizations. We demonstrate the empirical merits of the model in an analysis of inter-hospital patient mobility within a regional community of health care organizations. In the empirical case study we develop, organizational sub-units are departments of emergency medicine (EDs) located within hospitals (organizations). Networks within and across levels are delineated in terms of patient transfer relations between EDs (lower-level, emergency transfers), hospitals (higher-level, elective transfers), and between EDs and hospitals (cross-level, non-emergency transfers). Our main analytical objective is to examine the association of these interdependent and partially nested levels of action with variation in waiting time among EDs – one of the most commonly adopted and accepted measures of ED performance. We find evidence that variation in ED waiting time is associated with various components of the multilevel network in which the EDs are embedded. Before allowing for various characteristics of EDs and the hospitals in which they are located, we find, for the null models, that most of the network variation is at the hospital level. After adding these characteristics to the model, we find that hospital capacity and ED uncertainty are significantly associated with ED waiting time. We also find that the overall variation in ED waiting time is reduced to less than a half of its estimated value from the null models, and that a greater share of the residual network variation for these models is at the ED level and cross level, rather than the hospital level. This suggests that the covariates explain some of the network variation, and shift the relative share of residual variation away from hospital networks. We discuss further extensions to the model for more general analyses of multilevel network dependencies in variables of interest for the lower level nodes of these social structures.     

The supply of volunteer labor: the case of hospitals

Little is known about the labor market for volunteers, but even less is known about the supply of volunteers to particular industries. This article examines the supply of volunteer labor to one industry, hospitals, and the choices that volunteers make among hospitals with different ownership attributes. Survey data of volunteers at four hospitals located in Madison, Wisconsin, are used to estimate the importance of a number of factors influencing people's willingness to volunteer at hospitals. We found that job opportunities in the labor market and tax rates affect the supply of volunteers. We also found that volunteers are not indifferent to the type of hospital at which they volunteer; a federal government hospital, a nonprofit state-owned teaching hospital, and other nonprofit hospitals were not perfect substitutes in the eyes of individual volunteers in our study.     

Hospital pricing: cost shifting and competition

The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its profits on them will be unable to do so, at least to the same extent as it did in the past. Increased competition in health care without consideration of the uninsured will decrease the uninsured's access to care.     

Hospital cost shifting, a continuing debate

This Issue Brief examines the evidence on hospital cost shifting. It defines cost shifting, explores the incentives facing hospitals and payers, reviews and critiques the new evidence on cost shifting, and discusses the policy concerns that arise from the new learning. Cost shifting has a precise and easily understood meaning. It does not mean that some payers pay different prices than others. Different prices are commonplace throughout the economy. Rather, cost shifting exists when the prices faced by one group of payers are higher because another group pays less. To be able to cost shift, a hospital must have market power, and it must not yet have fully exercised that power. There has been a spate of recent cost-shifting studies. The better known studies focus on industrywide, revenue-to-cost margins by payer. They find that the extent of cost shifting declined in the mid-1990's. The methods underlying these studies have been criticized in the academic literature, with the strong suggestion that the studies overstate any true cost shifting. Cross-sectional studies compared measures of prices across individual hospitals. These studies have failed to find evidence of hospital cost shifting. However, they suffer from a potential inability to control for levels of service, quality, and amenities that may simultaneously have changed as well. Dynamic studies compare individual measures of hospital prices through time and allow each hospital to serve as its own control. These studies find no evidence of hospital cost shifting. As one analysis concluded: "We found no evidence to suggest that cost-shifting strategies that might protect hospital revenues in the face of financial pressure were undertaken successfully." Rather than cost shifting, the existing evidence points to hospital competition limiting the provider's ability to raise prices. Whatever market power hospitals once enjoyed is disappearing--and with it the ability to cost shift. This research suggests that Medicare reform or Medicaid restructuring will have little direct effect on the hospital prices that employers and their workers pay for health care. The author argues that cost shifting is dead. However, the increased hospital competition necessarily squeezes hospital profits. This reduces the amount of charity care they can provide. Expect to see more and more examples of hospitals unable to provide care to nonpaying patients. This also suggests that care for the indigent will become a more pronounced public issue. This is a form of "cost" shifting, one that the "system" will need to deal with.     

A comparison of organisational climates of public and private hospitals abroad

Are organisational climates in private hospitals compared to public hospitals, more favourable? To assess the differences, motivational orientations, perceived satisfaction with intrinsic aspects of the job, professional commitment orientations and perceived organisational climates by the medical professionals, senior administrative and professional nursing personnel are compared. All the groups in the public hospital tended to be higher in motivational orientations. On the other hand, all the groups in private hospital showed higher satisfaction with intrinsic aspects of the job, professional commitment orientations, and perceived favourableness of the organisational climate. The differences were found to be not significant.     

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.

The sequence analysis of hospitals that established social work department under fuzzy environment

This paper reviews the existing literature on hospital social work and discusses intervention strategies for improving social work practice in hospital. The objective of this study was to improve the quality of medical care. But few studies have compared social work services between different hospitals. This study describes qualitative analysis under fuzzy environment, extracts the main influencing factors and establishes a comprehensive evaluation index system. It provides comprehensive evaluation for alternative hospitals by the fuzzy clustering method. This paper proposes a new mixed fuzzy clustering algorithm on the basis of analysing the axiomatic fuzzy set (AFS) and K-means algorithm, which is not affected by some complicated parameter issues and has higher statistical validity. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is applied for selecting the best option for each cluster and a comparative analysis is done. Results from a case study in Shanghai, China, confirm that the proposed approach is effective by using information entropy to test. By comparing AFS, K-means and C-means algorithms, the hybrid algorithm can find the two closest attributes of evaluation index of hospital social work, and the proposed approach can be easily help raise the level of hospital social work service.     

Wages,productivity, and costs in union and nonunion hospitals

This paper considers the effects of labor unions on the economic performance of hospitals. Two data sets are considered. The first includes 275 hospitals from 13 urban areas; the second includes 114 hospitals from Ohio. The analysis is designed to determine whether or not union-induced productivity improvements occur within the rather noncompetitive hospital market and questions whether or not there are cost differences between union and nonunion hospitals. On the question of productivity, both data sets indicate that positive effects occur in the hospital sector. The answer to the second question is less clear. The primary data set indicates that unionized hospitals actually have lower costs than their nonunion counterparts, while the Ohio sample indicates that unionized hospital costs are lower, but not significantly so. The author wishes to thank Donald R. Williams and an anonymous referee for their valuable comments.     

Hospital ownership and performance

This study compares the performance of three ownership forms of hospitals: for profit, private nonprofit, and public, further classified according to whether or not the hospital is run by a hospital chain. Data come from a 1979 national survey of U.S. hospitals. The authors find that hospital cost is quite similar among alternative ownership forms as is profitability. The results do not provide much empirical support for standard property rights theory. Several reasons are suggested why this may be so.     

Does Revenue Diversification Predict Financial Vulnerability Among Non-governmental Organizations in sub-Saharan Africa?

Non-governmental organizations (NGOs) in sub-Saharan Africa (SSA) experience financial challenges that hinder efforts to promote social change and development. Revenue diversification is one adaptive response to these challenges, yet there is a lack of evidence concerning the relationship between revenue diversification and financial vulnerability among NGOs in SSA. Using data from an online survey of NGOs (N = 170), we hypothesized that a greater number of revenue sources is associated with lower probability of financial vulnerability, while a greater level of dependence on international funding is associated with higher probability of financial vulnerability. Results from probit regression models controlling for organizational characteristics indicated partial support for hypotheses. Having four or more types of revenue was associated with 87% lower probability of financial vulnerability compared to having one type of revenue (p < 0.001). Also, NGOs with up to half of their budgets covered by international sources had 17% lower probability of financial vulnerability compared to NGOs with no international funding (p < 0.05). Implications for future research to further explore these relationships are discussed.     

Risk and diversification of nonprofit revenue portfolios: Applying modern portfolio theory to nonprofit revenue management

This study uses modern portfolio theory (MPT) to estimate the risk of nonprofit revenue portfolios and examines to what degree the revenue concentration measure based on Herfindahl–Hirschman Index is associated with the portfolio risk measure based on MPT. The findings suggest that nonprofits with greater revenue concentration have lower revenue portfolio risk in the whole sample analysis. However, it is plausible that this result is dominated by organizations reliant on commercial income, which comprise over half of the sample. In fact, when examined separately, the relationship varies by an organization's primary funding structure. While higher revenue concentration is positively associated with portfolio risk for organizations relying on donations or those without a consistent primary funding source, it appears to associate with a lower portfolio risk for commercial organizations and those relying on government grants. This study reflects on the concept of diversification derived from portfolio theory and calls attention to a more nuanced approach to nonprofit revenue strategy.     

Targeting occupations with varying reputations to increase tax revenue

If the government's goal is to raise tax revenue in a cost-effective manner, which (if any) occupation categories could be targeted with a higher probability of an audit to yield increased revenue? Looking beyond mere opportunity to evade (e.g., self-employment) and starting from the premise that taxpayers in certain occupations evade more than others, the issue is whether these taxpayers respond to a change in the audit rate. Theory suggests that compliance increases in response to higher audit rates; the occupations with the higher evaders could therefore be targeted. This theory is tested by drawing a connection between occupation, reputation, and tax compliance. We assume that taxpayers in occupations with high need for reputation respond to a lower extent to increased tax audits than taxpayers whose achievement does not depend on reputation. The results support the effectiveness of raising tax revenue by targeting specific occupations, non-managers, with a higher probability of an audit.     

THE DEMISE OF HOSPITAL PHILANTHROPY

We develop a one-period model of hospital and donor behavior to analyze how insurance for hospital care, various public subsidies, and other factors affect donations to hospitals. Theoretically, increased insurance coverage has an ambiguous effect on private giving. Empirical tests using time series and cross-sectional data show that the growth of private insurance and especially the introduction of Medicare and Medicaid substantially reduces private giving to hospitals. Effects of public subsidies for construction depend on whether the subsidy more closely resembles a matching or lumpsum grant.