Profit vs. Non Profit Healthcare Organizations
Prepared By: Milton Flores
Table of Contents
I. Introduction……………………………………………………………………………………………………………………………………3
II. Definition of Non Profit Health Care Organization………………………………………………………………………….4
III. Definition of Profit Health Care Organization…………………………………………………………………………………4
IV. Issues facing Non Profit and Profit Health Care Organizations……………………………………………………….5
V. Options to improve operations……………………………………………………………………………………………………….6
I. Introduction
The debate on whether all healthcare institution should be non-profit rises many issues and they have been heavily debated. The best way to examine this to analyze if non-profit hospitals are in fact better that for
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Non profit health plans are estimated to serve over 40% or more of all private health insurance enrollees.
Nonprofit health care organizations are primary responsible and accountable to the communities and populations they serve. They are legally and ethically bound to do good for the benefit of their communities. Their governing bodies are comprised of leaders from the communities they serve. The earnings and reserves of nonprofit health care organizations are reinvested to benefit the community.(1).
III. Definition of Profit Health Care Organization.
For- profit health care and organizations have a misconception that this automatically means higher costs and a lower level of quality. There are several studies that directly contradict this assumption. In a study that was conducted by Blue Cross, the findings showed that there was not an increase in costs and that there was not a negative effect on the availability of health care.
For profit providers look at health care as a business, with a financial bottom line producing profits that can be distributed to shareholders. Supporters of for-profit health care say that increased competition can produce a more efficient, effective, less expensive health care system. Since the 1980s, for-profit health care facilities have proliferated, including national hospital chains, health plans,
In 1997 University of California, San Francisco (UCSF) merged its two public hospitals with Stanford’s two private hospitals. The two separate entities merged together to create a not-for-profit organization titled UCSF Stanford Health Care. The merger between the health systems at UCSF and Stanford seemed like a good idea due to the similar missions, proximity of institutions, increased financial pressure with cutbacks in Medicare reimbursements followed by a dramatic increase in managed care organizations. The first year UCSF Stanford Health Care produced a profit of $22 million, however three years later the health system had lost a total of $176 million (“UCSF-Stanford Merger,” n.d.). The first part of this paper will address reasons
Millions of dollars are spent on healthcare every year in USA but the health of the beneficiaries has not increased accordingly. Just providing healthcare is not enough; quality healthcare with long term benefits should be the aim of the healthcare providers. I have studied and worked in certain multi-specialty hospitals and government facilities in my home town. I have seen corruption and frauds happening at various levels and hence wanted to study about how such non profit and
A for-profit healthcare organization may be formed to conduct business activities pertaining to healthcare. The primary reason in forming a for-profit healthcare organization is to earn a profit for the investors of the company. With regard to for-profit healthcare organizations, the profits of the company are distributed to the owners or investors of the company in the form of dividends after EBITDA is calculated. A for-profit healthcare organization allows a business owner to obtain gains from the organization if the business remains profitable. A not-for-profit healthcare organization is formed for the good of the community. Not-for-profit healthcare organizations are formed for religious, charitable, or philanthropic purposes. The revenue raised by the not-for-profit healthcare organization must be reintegrated into the organization, so it is able to achieve its
“The U.S. spends nearly twice as much money per capita on health care as other developed nations, yet the metrics show that Americans end up with worse care and poorer health.” (Hill) The rising cost of healthcare has pushed some non-profits to become for-profit organizations.
In the United States, healthcare costs are among the highest in the world. Due to the privatized system, this results in high administrative expenses, high spending on marketing, billing, and profit
The private health sector tends to be beneficial for the service user who can afford quality treatment leaving others having to rely on the states medical interventions which includes long waiting lists and several appointments before diagnosis.
Nonprofit hospitals have become a common characteristic of the hospital sector because they can be found across the country because of their presence in almost every corner, they never decline to provide treatment, and offer several community-based health programs. On the contrary, the for-profit health facilities are regarded as the corporate model of health care services as they seek to make profit first. They enjoy huge capital that enables them to develop state-of-the-art facilities and purchase the latest clinical technologies.
The largest for profit healthcare carrier in the United States (US) is UnitedHealth Group, the parent of UnitedHealthcare.
Though they are not entirely comprehensive tools, a great deal can be learned about a hospital or other healthcare organization for-profit or not-for-profit from an examination of their annual financial documents (Finkler & Ward, 2006). The balance sheet and statement of revenue and expense can both yield valuable clues even in the absence of other evidence about changes that might be occurring in the organization, a definition of the type and degree of certain problems that it might be facing, and potential opportunities for improvement in performance that might exist (Finkler & Ward, 2006). Comparing two or more years' worth of financial information yields even more valuable insights, tracking movement in the hospital or other organization's ability to finance its activities and thus continue providing services at the same level, quantity, and scope as current operation.
In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary
A comparison will be held against non-profit hospitals and for-profit hospitals in regards to their operating costs focused on uncompensated care and their operating profit margins. The locations and statuses of the hospitals will also be taken into account and explained to add more context and clarity to the true meaning of their dollars. The comparison will be displayed not only in a paragraph format but also in a bar graph visual to accentuate and clarify the either vague or noticeable difference between the hospitals.
Globally, the United States has one of the largest and most convoluted healthcare systems, whereas universal healthcare coverage seems extremely farfetched. Annually, the US spends over $3 trillion on healthcare. Nevertheless, we have the worst health outcomes when compared to other industrialized countries. As stated by Anja Rudiger (2008), “Recent data suggest that around 101,000 deaths a year can be attributed to the underperformance of the US healthcare system.” Thus, the United States’ healthcare system greatly relies on revenue. Both funding and the distribution of services are commercially structured and held accountable by investors to increase financial gains. According to Andrew Jameton and Jessica Pierce (1997), “the US healthcare system increasing appears to have
The major objectives of healthcare financial management include: generating income (which is the most important) because it is the financial status of the organization. It is important to ensure that revenues are exceeding expenses. After assets are invested in, they are meant to be used. They must respond to regulations and be accredited to qualify for loans, reimbursements, etc. Facilitate relationships with third-party payers because they are the ones helping with the bills. The health organizations must also influence method and amount of payment to avoid overpaying, when faced with capitated prices or prospective payments. Monitoring physicians is important because they are at the forefront of everything, so management must make sure that physicians’ orders are consistent with patient needs. Lastly, protecting tax status involves for-profit organizations trying to reduce tax liabilities, while not-for-profit organizations try to protect their tax-exempt
In the United States almost all levels of healthcare are delivered by the private sector providers. Many hospitals and health facilities are owned and run by profit making companies. Doctors and other health workers are either independent practitioners or happen to work for private-sector healthcare institutions. Access to healthcare is acquired through
The non-profit, for-profit, and governmental hospitals have certain policies and financial forms that are unique to each organization. The non-profit