The Influence of Ownership on Hospital Board Governance and Strategic Cost Management PDF Download

Author: Kathryn J. Chang
Publisher:
ISBN:
Category :
Languages : en
Pages : 180

Get Book Here

Book Description
In this dissertation, I attempt to study the equilibrium behaviors of for-profit and nonprofit hospitals in a monopolistic competitive market, and to empirically test whether there is a measurable difference in board governance practices and strategic cost management approach across hospital ownership types. Chapter 1 offers a brief introduction to three manuscripts that analytically and empirically examine the relationship between ownership forms and hospital behaviors pertaining to board governance and strategic cost management. Chapter 2 develops a theoretical model to explain the equilibrium behavior and outcome of nonprofit hospitals as compared to for-profit hospitals in a monopolistic competitive market. I find that nonprofit hospitals tend to maximize quantity of services by offering a broad range of services at relatively low prices, irrespective of the ability of these hospitals to obtain additional funds and the size of the subsidy. However, subsidized hospitals are able to further lower price to attract more patients but still manage to break even. Moreover, nonprofit hospitals are relatively more efficient by maximizing economic welfare (the sum of consumer surplus and producer surplus) and operating at economies of scale. Such finding contradicts the conventional view that for-profit is a more efficient type of ownership form (Clarkson, 1972; Clark, 1980; Cutler and Horwitz, 2000) but is consistent with empirical findings that predominantly favor nonprofit hospitals (Rosenau 2003; Rosenau and Linder 2003; Schlesinger and Gray 2006). Therefore, this paper provides theoretical explanation for the performance paradox of nonprofit hospital. Three propositions derived from the model can be further developed into testable hypotheses for future empirical research. Chapter 3 empirically investigates the relationship between board / CEO turnover and hospital performance, as well as the incremental effects of ownership type on hospital board governance practices. It develops the hypotheses that claim the substandard performance increases board / CEO turnover and the propensity of boards using certain performance measures is different between for-profit and nonprofit hospitals. Departing from prior studies, this paper applies factor analysis to examine the usefulness of multiple financial and nonfinancial performance measures in estimating the determinants and factors leading to board / CEO turnover. Using a sample from California short-term general, acute care hospitals, I find that multiple financial and nonfinancial performance measures are useful accounting signals of board governance practices. Moreover, the sensitivity of boards toward certain performance measures is affected by hospital ownership status only in the CEO replacement decision. Chapter 4 empirically examines the influence of ownership on strategic cost management (SCM) and its performance consequences in the health care industry. Drawing upon the property rights theory and prior accounting literature, it develops the hypotheses that predict the ownership type would affect the extent to which the hospital strategically manages revenues and costs of operation, leading to improvement in financial performance. The results suggest that the ownership type does play a significant role in the choice of SCM strategies along the dimension of revenue-enhancing and cost reduction across a sample of U.S. hospitals. Moreover, there is strong evidence that the association between the extensive use of SCM strategy and hospital financial performance is a function of the "match" between SCM use and a hospital's ownership type, operating characteristic and market environment.