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Economic Incentives in the Hospice Care Setting: A Comparison of For-profit and Nonprofit Providers

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  • Forgione, Dana
  • Noe, Kelly

Abstract

The purpose of this paper is to examine the association of differences in economic incentives between for-profit (FP) and nonprofit (NP) hospice care providers with management performance using financial and nonfinancial metrics. This research is based on the expectations of Agency theory and applies proxies of the quality of patient care while controlling for differences in cost-efficiency. Our findings indicate that FP hospice providers (1) selectively admit patients with longer life-prognoses and billable days and hence lower average costs per day (2) employ a lower average cost/skill mix of workers and (3) have higher CEO compensation and profit. The NP providers admit more patients with the less profitable life-prognoses attributes have lower CEO compensation and reinvest their net earnings under the non-distribution constraint. While the profit incentive may be needed to attract providers into this rapidly growing and underserved market the NP providers return a lower cost per patient served from the taxpayer's perspective.

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  • Forgione, Dana & Noe, Kelly, 2011. "Economic Incentives in the Hospice Care Setting: A Comparison of For-profit and Nonprofit Providers," Working Paper Series 19195, Victoria University of Wellington, The New Zealand Institute for the Study of Competition and Regulation.
    • Handle: RePEc:vuw:vuwcsr:19195
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    File URL: https://ir.wgtn.ac.nz/handle/123456789/19195
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    1. Jensen, Michael C. & Meckling, William H., 1976. "Theory of the firm: Managerial behavior, agency costs and ownership structure," Journal of Financial Economics, Elsevier, vol. 3(4), pages 305-360, October.
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    3. Lindrooth, Richard C. & Weisbrod, Burton A., 2007. "Do religious nonprofit and for-profit organizations respond differently to financial incentives? The hospice industry," Journal of Health Economics, Elsevier, vol. 26(2), pages 342-357, March.
    4. Fama, Eugene F, 1980. "Agency Problems and the Theory of the Firm," Journal of Political Economy, University of Chicago Press, vol. 88(2), pages 288-307, April.
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