Efficiency and profitability in US not-for-profit hospitals

Int J Health Econ Manag. 2020 Dec;20(4):359-379. doi: 10.1007/s10754-020-09284-0. Epub 2020 Aug 20.


This article examines the relationship between hospital profitability and efficiency. A cross-section of 1317 U.S. metropolitan, acute care, not-for-profit hospitals for the year 2015 was employed. We use a frontier method, stochastic frontier analysis, to estimate hospital efficiency. Total margin and operating margin were used as profit variables in OLS regressions that were corrected for heteroskedacity. In addition to estimated efficiency, control variables for internal and external correlates of profitability were included in the regression models. We found that more efficient hospitals were also more profitable. The results show a positive relationship between profitability and size, concentration of output, occupancy rate and membership in a multi-hospital system. An inverse relationship was found between profits and academic medical centers, average length of stay, location in a Medicaid expansion state, Medicaid and Medicare share of admissions, and unemployment rate. The results of a Hausman test indicates that efficiency is exogenous in the profit equations. The findings suggest that not-for-profit hospitals will be responsive to incentives for increasing efficiency and use market power to increase surplus to pursue their objectives.

Keywords: Hospitals; Payment policy; Profits; Stochastic frontier analysis.

MeSH terms

  • Bed Occupancy / economics
  • Cross-Sectional Studies
  • Data Interpretation, Statistical
  • Efficiency, Organizational*
  • Financial Management, Hospital / economics
  • Financial Management, Hospital / organization & administration*
  • Hospital Bed Capacity / economics
  • Humans
  • Length of Stay / statistics & numerical data
  • Medicaid / statistics & numerical data
  • Medicare / statistics & numerical data
  • Multi-Institutional Systems / economics
  • Organizations, Nonprofit / economics
  • Organizations, Nonprofit / organization & administration*
  • Socioeconomic Factors
  • United States