A consumer group joined the parade last week in putting for-profit hospitals under the microscope.
The American Association of Retired Persons released a study that said that when a hospital converted from not-for-profit to for-profit status, the byproduct was often management instability.
This instability happens because of frequent management changes by the new for-profit owner or because the hospital is later resold to a succession of new owners, the report said.
"When a hospital is in the throes of management instability, it isn't a community player the way a hospital that is more stable can be," said Deborah Chollet, one of the study's authors.
The study was conducted for the AARP by the Alpha Center in Washington, a not-for-profit healthcare policy research group, where Chollet is vice president.
The study puts a consumer spin on the hospital ownership debate, an area crowded with literature from special-interest groups representing one side or the other (April 6, 1998, p. 20).
The AARP-37 million members strong-pursued the study because its members are concerned about the changing healthcare market.
"There is anxiety," said JoAnn Lamphere, senior policy adviser for the AARP.
A spokesman for the Federation of American Health Systems, a national trade association representing for-profit hospitals, said the group had not yet seen the AARP report.
The study looked at seven hospital conversions that took place between 1983 and 1994.
Nearly all the deals happened before states began passing laws to govern such changes in ownership, the report noted.
The report details seven initial hospital conversions in Alabama, Georgia, Illinois, Indiana, Missouri, New Mexico and Tennessee.
Besides raising the issue of management instability, Chollet said, the study sends a second message.
"The public should not read mission into for-profit or not-for-profit status," she said.
A hospital's chosen tax status is often nothing more than an artifact of history or a financing decision.
"All the not-for-profits are not good guys, and all the for-profits are not bad guys," she said.