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Strategic and economic factors in the hospital conversion process.

Cost containment and managed care pressures are driving hospitals to consolidate. Affiliation proposals from not-for-profit and for-profit partners will offer fundamentally different solutions to governance and economic issues. A clear definition of goals; an open, conflict-free proposal process; and a good understanding of value are the key ingredients of a successful transaction and regulatory approval, especially in an environment of heightened political interest in conversions.

Community-Institutional Relations↗
PubMedDate not supplied

Hospital conversion trends.

This DataWatch presents information on the extent, geographic distribution, and other issues related to hospital conversions during the 1980s and 1990s. On average, 1 percent of hospitals convert each year. Many states experienced hospital conversions, but much of the conversion activity was concentrated in California, Florida, Georgia, and Texas. While conversions of not-for-profit hospitals to for-profit status have received significant attention, conversions of public hospitals and for-profit hospitals raise complex policy issues, as well.

Bed Occupancy↗
PubMedDate not supplied

Conversion of HMOs and hospitals: what's at stake?

Because for-profit conversions of nonprofit organizations are regulated under trust law at the state level, their health policy implications have generally not been part of the process. This paper provides a health policy framework for assessing conversions of hospitals and health maintenance organizations (HMOs). It begins with basic differences in ownership forms and identifies considerations on both sides of the conversion question. The analysis turns on the extent of the social benefits of nonprofits: the regulatory tool provided by tax exemptions, trustworthiness in the presence of informational asymmetries, and community benefit activities. The analysis and the evidence suggest that the nonprofit form continues to hold significant advantages in health care that bear consideration by policymakers faced with conversion proposals.

Health Facility Merger↗
PubMedDate not supplied

State experience in regulating a changing health care system.

Conversions of nonprofit hospitals, health maintenance organizations (HMOs), and Blue Cross and Blue Shield plans to for-profit status have tremendous social and economic consequences for communities. Although some consensus exists on the legal principles governing hospital conversions, a coherent legal framework for processing many other conversions is often lacking. Rapid changes in the configuration of health plans and providers complicate the situation. Litigation will provide some resolution of the issues but is not an optimal way of making policy. Some state legislatures are stepping into the fray with differing solutions. Currently, the approach of a particular regulator is often the most important determinant of a given conversion.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

State policy issues in nonprofit conversions.

The increasing number of nonprofit hospitals and health plans converting to for-profit enterprises, public concern, and media attention have brought conversions to the top of state policy agendas. Conversions raise public policy issues because nonprofit corporations' legal status obligates them to operate in the public interest, their tax subsidies should not inure to the benefit of private interests, and they often represent unique community resources providing valuable services. This paper describes legal authority that states can use to oversee conversions and outlines several policy issues facing state regulators that could be addressed by new legislation.

Facility Regulation and Control↗
PubMedDate not supplied

A road map from Nebraska.

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Community-Institutional Relations↗
PubMedDate not supplied

Public policy issues in nonprofit conversions: an overview.

Conversions raise two critical policy questions: First, does ownership form (nonprofit or for-profit) make any difference to delivery of health care? Second, when conversions occur, how are charitable assets and purpose preserved? This paper addresses both questions, based on a review of evidence and experience. On the first question we conclude that, overall, nonprofit ownership enhances the potential for community benefit. However, that potential may be better realized by requiring nonprofits to meet minimum community benefit standards and possibly by mitigating pressure on institutions to convert. On the second question, we conclude that more states should take legislative action to establish a formal oversight process for conversions. Without public consideration of how much money to set aside and for what purpose, conversions pose the risk that communities will lose significant services and resources.

Health Facility Merger↗
PubMedDate not supplied

The view from Ohio.

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Blue Cross Blue Shield Insurance Plans↗