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Managerial compensation and incentives in for-profit and nonprofit hospitals
Authors:Roomkin  MJ; Weisbrod  BA
Institution:0 American University
1 Northwestern University
Abstract:Differential economic behavior of for-profit and nonprofit institutionscan be manifest in both output and input markets. When behaviorin output markets is difficult to observe, behavior in inputmarkets can be useful proxies. We examine monetary compensationand its composition between base salary and bonus, and the associatedincentive structures, in the U.S. hospital industry. Our datapermit controlling for interinstitutional differences in thescope and complexity of jobs having the same titles, as wellas differences in organization size and other variables. Wefind (1) total monetary compensation for the two top executivejobs is substantially higher in the for-profit sector; and (2)the composition of compensation as between base salary and bonusdiffers materially across forms of organization, bonuses beingabsolutely and relatively greater in the for-profit sector.Particularly noteworthy is the finding that for-profit hospitalsutilize compensation mechanisms that, by involving larger contingentcomponents, provide stronger incentives - greater rewards -as compared with nonprofit hospitals, for performance that ismore easily monitored. While our findings are consistent withmore than one model of comparative organizations differ in theirgoals and, hence, in the kinds of managers they demand and thereward structures they offer. Nonprofit organizations may pursueobjectives that reflect greater concern about collective goodsor other outputs that are more difficult to measure and reward.Alternatively, nonprofits, confronted by a nondistribution constrainton the payout of profit to managers, may lack incentives forefficiency, and so may pursue other goals such as a quiet life.Such differential objective functions, together with the differentialconstraints on the distribution of profit to managers, havetwo kinds of implications. (1) Nonprofit and for-profit organizationsmay attract different kinds of managers, especially at the toplevels, because nonprofits prefer working for a nonprofit organizationand, hence, may offer a lower supply price to them. (2) Thetwo types of organizations can be expected to offer differentialcomposition of compensation as between base salary and performance-basedbonus, providing different incentives for managers. Our analysisis positive in character, the goal being to identify systematicdifferences in organization behavior.
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