[Regarding “Healthy Competition: AdventHealth, HCA and Novant Health to Apply for Hospital Beds,” June 8, Xpress:] HCA must not be the only hospital available to WNC. The government must approve a nonprofit hospital.
Competition is a good thing.
— Michael Reilly
Marshall
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You are obviously taken in by the word nonprofit. Spend 5 minutes googling and you’ll see there is no difference in pricing or quality between nonprofit and for profit hospitals. The top 20 hospitals in the country are a mix of both. Nonprofits just use their profits to support their institution (university and church affiliated hospitals) or for philanthropic purposes.
While true that the differences between for-profit and nonprofit hospitals may not always be apparent in pricing, clearly the incentives shaping their decisions are different, and this does have an impact on the kind and quality of care a community receives. Studies have shown, for instance, that for profit hospitals are much quicker to respond to market incentives. This focus on the bottom line often results in for-profit hospitals shifting more resources to higher end, high cost, more profitable care, where something close to factory model metrics can be imposed (i.e., ER care, heart surgeries, etc.). While this may be a good thing for patients needing those specific services, the same studies also show that resources are often taken away from lower or no-profit primary care (which can be more even more essential to the overall health and well being of the general population), or from the maintaining of facilities outside of urban population centers. The coverage provided by Mountain Xpress on the law suit against HCA brought by the town of Brevard illustrates the point. https://mountainx.com/news/from-cpp-why-small-nc-mountain-city-is-taking-on-nations-largest-hospital-system/
As to how these different incentives have specifically been playing out in the HCA/Mission system, the same 5 minutes spent looking up some of the local coverage on why so many doctors have left HCA/Mission, and how their for-profit mode of operation has been impacting the type and quality of care they provide, only reinforces the point that there are significant trade-offs and differences in service delivery which hinge on the different incentives shaping the decisions of for-profit vs. nonprofit hospitals. The three part investigative series published by Asheville Watchdog is a good place to start.
https://avlwatchdog.org/how-many-doctors-have-left-mission-hca-wont-say/
Disagree that nonprofits and for profits have significantly different incentives. Nonprofits simple channel their profits not to shareholders, but to other stakeholders.
No doubt that different health strategies are pursued by different players. Not sure the choices are related to profit/nonprofit. Mission, for example, tried to corral every physician group near Asheville under its umbrella. HCA chooses not to be a big player in that space.
Looking at one side of a lawsuit is not especially interesting. Let’s see how Brevard makes out.
Having long worked in industries with lots of unionized labor, the safety card is the first card played in what is essentially a compensation arm wrestle.
“Let’s see how Brevard makes out.” …and the private citizen class action suit, and the Asheville/Buncombe law suit, and the state Attorney General’s appeal, and the voices of many thousands of residents who have now petitioned state authorities, looking to have an entity other than HCA open a new hospital in order to provide some alternatives and competition. Somehow I’m thinking there may be more to this than just a lot of folks who have been “taken in by the word non-profit.”
We need something beside HCA. Anything would be an improvement.
https://www.wsj.com/articles/nonprofit-hospitals-vs-for-profit-charity-care-spending-