Should Nonprofits Hospitals Receive Special Care?

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Imagine a community hospital that provides vital care to those in need, regardless of their ability to pay. Now, imagine this hospital considering a merger to expand its services. Should the rules that govern business mergers apply equally to this hospital, given its nonprofit status and commitment to public welfare? This is the central question explored in a recent study that investigates whether nonprofit hospitals should receive special antitrust treatment.

The Nonprofit Advantage?

Nonprofit hospitals in the United States make up a significant portion of the healthcare landscape. Unlike for-profit hospitals, nonprofits do not distribute profits to shareholders. Instead, they reinvest any surplus into providing care, particularly for underserved populations. In exchange for these public benefits, nonprofits enjoy tax exemptions. However, the question arises: should nonprofit hospitals also receive lenient treatment under antitrust laws when they seek to merge or increase their market power?

The argument in favor of leniency is straightforward: increased market power might enable nonprofit hospitals to generate more revenue, which could then be used to provide more charity care. However, this assumption rests on the belief that nonprofit hospitals with greater market power do indeed provide more charity care. The study by Capps and his colleagues seeks to test this very premise.

The Study’s Approach

To understand the relationship between market power and charity care, the researchers developed a theoretical model and then tested it using real-world data from California hospitals over a decade (2001-2011). They used three different measures of charity care: two monetary-based and one based on the volume of services provided.

  1. Monetary Measures: These include the reported dollars spent on charity care and the total uncompensated care (charity care plus bad debt).
  2. Service Volume: This measure captures the actual inpatient services provided to uninsured patients.

By analyzing these measures, the researchers aimed to determine if nonprofit hospitals, when given more market power through mergers or other means, actually increased their provision of charity care.

Findings: Nonprofit vs. For-Profit Hospitals

Contrary to what some might expect, the study found no significant evidence that nonprofit hospitals provide more charity care as their market power increases. In fact, when comparing nonprofit and for-profit hospitals, there was little difference in how they responded to increased market power in terms of charity care provision.

  • Charity Care: Both types of hospitals showed similar patterns in the provision of charity care, suggesting that increased market power does not lead nonprofits to provide more charity care.
  • Unprofitable Services: Nonprofit hospitals were no more likely than for-profit hospitals to offer unprofitable services like trauma care or burn units when they had greater market power.

These findings challenge the notion that nonprofit hospitals should be treated more leniently under antitrust laws based on the assumption that they will use increased market power to provide more public benefits.

Why Should You Care?

The implications of this study are significant for policymakers, healthcare providers, and the general public. If nonprofit hospitals do not use increased market power to provide more charity care, the rationale for giving them special treatment under antitrust laws becomes questionable. This could influence future legal and regulatory decisions regarding hospital mergers and the overall structure of the healthcare market.

Moreover, understanding how hospitals operate and are regulated can help consumers make more informed decisions about their healthcare options. It also highlights the importance of ongoing oversight to ensure that hospitals, whether nonprofit or for-profit, are truly serving the public good.

Let us know in the comments below!

  1. Have you or someone you know received care at a nonprofit hospital? How did your experience compare to care received at a for-profit hospital?
  2. How do you think hospital mergers affect the quality and availability of healthcare services in your community?


This study provides valuable insights into the dynamics of charity care provision by nonprofit hospitals. It suggests that, despite the advantages nonprofits enjoy under tax laws, their performance in providing public benefits does not necessarily justify special treatment under antitrust laws. As the healthcare landscape continues to evolve, these findings underscore the need for balanced policies that ensure all hospitals are held accountable for delivering on their promises to the communities they serve.

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