Strengthening Social Protection in East Asia,Mukul G. Asher and Fukunari Kimura (Eds.)

Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that—under a cost-based payment system—nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services.     

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.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

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.     

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.     

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.     

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)     

The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Child center closures: Does nonprofit status provide a comparative advantage?

Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30 +) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.     

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)     

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.     

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.     

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.     

Executive Compensation in the Nonprofit Sector

An examination of executive compensation in the nonprofit sector indicates that, as in the for-profit sector, the salaries of nonprofit executive directors depend heavily upon the organization's size. Among nonprofits, both ideology and the composition of revenues substantially affect executive compensation levels. The results of this study indicate broad differences across segments of the nonprofit sector and a strong role for ideology in the setting of compensation.     

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 Adoption of the Corporate Governance Model by Nonprofit Organizations

This article examines the circumstances under which nonprofit organizations adopt corporate governance practices. In the study reported here, the authors found that adoption of corporate governance practices depends primarily on the presence of a supportive institutional (that is, value) context as well as available resources to support governance restructuring. These findings strongly suggest that the adoption of structures and practices from the for-profit sector is neither a feasible nor even a desirable solution to problems facing many nonprofit organizations.     

Leading collective action to address wicked problems

The alleviation of wicked problems requires collective action because these issues are characterized by significant uncertainty and complexity. This research extends prior work by examining how conveners' use robust action to navigate wicked problems' defining characteristics in the mobilization process. It provides a longitudinal study of a health care nonprofit attempting to engage other stakeholders in addressing the high costs and inadequate quality of health care in a region of the United States. Specifically, the convener sought to address this wicked problem by developing a health information exchange. The findings relate five robust action tactics through which the convener advanced collective action.     

Linking For-Profit and Nonprofit Executive Compensation: Salary Composition and Incentive Structures in the U.S. Hospital Industry

Research concerning executive compensation has a long history. However, most studies have been conducted on publicly traded investor-owned enterprises. Although the not-for-profit sector experienced explosive growth during the 1990s, little work has been devoted to understanding its executive compensation schemes and incentives arrangements. In the United States, recent Federal and State legislation has changed the landscape under which nonprofits must operate to avoid penalties for paying excessive compensation to its executives. Studies of compensation schemes under different organizational arrangements are limited. This paper uses the U.S. hospital industry to link the for-profit and nonprofit compensation and incentive literatures. It highlights selected for-profit executive compensation and incentive processes and suggests how some of these methods could be applied in a nonprofit setting.     

Profits and incentive compensation in nonprofit firms

Incentive contracts based on profit sharing, cost reduction, or other measures of performance no longer need to endanger a nonprofit firm's tax exemption; such measures have been urged for adoption in the nonprofit sector. However, the nonprofit differs from the for-profit sector in that contracts have side effects on the solicitation and offering of donations and on the character of those who choose to work in the nonprofit sector. In addition, it is more difficult in the nonprofit sector to obtain an appropriate output measure for use in calculating bonuses.