The non profit health sector includes hospitals, nursing homes, home health care services, family planning clinics, blood banks, mental health centers, programs for different types of addicts.
Health care is the largest part of the non-profit sector. Nonprofit general hospital revenue and employment are overwhelmingly larger than either government or for-profit activity, three times larger than government and seven times larger than for profits. General hospitals account for 93% of revenue and 92% of employment of all hospitals.
For profit firms dominate out patient care: three-fourths of all ambulatory care revenue goes to the exclusively for profit categories of doctors’ offices and medical and diagnostic labs. One important fact is that fees for services include both government and private funds. Government fee sources include Medicare and Medicaid programs. Private fee sources come from employer’s individuals, insurance companies, and health maintenance organizations (HMO’s).
Private funds from health plans and individuals paid for 49% of health care in 2000, where as government funds paid for 45%.
By the end of the 20th century non profit health institutions were often part of large health systems, more secular, businesslike, funded almost exclusively by the government and private payments and sometimes accused of being unresponsive to patients without insurance or other resources. This is compared to the 50’s where health institutions were scattered supported by private payments and charitable donations.
Health insurance organizations are a mix of non profit for profit and governmental.
I think that due to the mix of non profit, for profit and governmental in health care we have a lot of problems. As a result, I wonder how the exchange of tax payer’s money and for profit health insurance companies money and involvement works with health care providers. It seams that in the beginning part of the 20th century health care was about the health and care of people and not as focused on money. In reading I realize that advances in technology and cost of equipment have raised prices, but couldn’t it still be more accessible?
I talk to my dad briefly asking him questions specifically about the government run public health care facility he worked for in Pennsylvania, he said:
The Pennsylvania Department of Health was involved with public health and the provision of health services for communicable diseases funded by government. This type of program was created from public interest to prevent the spread of diseases. So there was a strong and practical importance for preventive health and education. But with the change in government under the Republican regime came privatization. Due to new control health care became for profit, where they are no longer interested in spending time and money on advancing preventive measures because they can’t make money prevention. An example of this type of privatization in the State Health Department, after constantly being degraded by people who wanted to privatize the Sexually Transmitted Disease health care services, the STD program paid the local (in Reading, PA) hospital 30 dollars for every patient they saw that came to the hospital to be examined. The state health department also paid for the medicine and tests. This provided free services to anyone who needed them. They did this because if someone didn’t have the money to get a check up, they wouldn’t get tested. The State Health Department provided this with tax payer’s money. With the change to privatization the PA dept. of Health was forced to contract a non-government organization who then subcontracted with the same hospital and clinic to provide free STD services. Instead of the 30 dollars that the hospital use to get per patient from the Health Department, they now get 20 dollars per patient and the contractor was charging 60 dollars per patient from the government. This was Pennsylvania tax dollars at work. So the contractor was making 40 dollars per patient. As a result the hospital could no longer afford to staff and provide services for the clinic, so it is now very difficult to receive those free services from that particular hospital.
What we have now is people talking up preventive health care but insurance company’s unwilling to pay for it. Insurance companies would rather pay for the end result of a surgery then a preventive test, resulting in a very confused non-system. Public health was designed to attempt to reduce and control diseases to save tax payers and insurance company’s money. These services were non for profit, for the benefit of the tax payer and the people who needed the services.
The second chapter in this weeks reading was on Education and Research. In the reading O’Neill compares public schooling to private schooling. I wasn’t surprised by the break down of private K-12 schooling. Public is often at least twice the size of private. The majority of private schools have a religious denomination. Though, the percentage of non sectarian or independent school was 16 percent which is lower than I had expected. 53 percent of 1998-1999 graduates of these private secondary schools go on to four year colleges or universities. In catholic schools the rate was 77 percent in other religious schools 48 percent and in non sectarian schools 76 percent.
Average tuition from 1993-1994 ranged from 1,628 for catholic grade schools to 9,525 for non sectarian high schools. Many religious schools are subsidized financially. There is a significant gap between public and private in educational degrees, for which there is generally more teachers at master’s level degrees in public because of more incentive than private. The age, teaching experience and degree differences may reflect the fact that salaries are on average significantly higher in public than in private schools; 34,153 in public vs. 21,968 in private.
I always associated more prestige to private schools than public. I assumed that because you are paying tuition for your child’s K-12 education it would be of a higher quality. But, these statistics show other wise. So then why would private school teachers get paid less if there institutions cost a significant amount of money? (The statistics in this book were distinguishing public and private not between private for profit and private non profit)
The book answers this a little bit further on; the private non profit colleges and universities receive 10 percent of their revenue from the government along with additional support indirectly through the government. In contrast very little government aid goes to private elementary and secondary education.
One would need to consider though, that the government may be giving money to a university for research. With a secondary school or private elementary schools they aren’t able to address those needs and it would be in violation of the first amendment to support a private religious secondary school. I think of private schools as an unnecessary elite option, so why should government have to support them as well as public schooling.
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