Returns on equity to not-for-profit hospitals: theory and implementation

It is argued that not-for-profit hospitals can be assumed to generate a return on equity capital due, in principle, to competition in the final product market for hospital services and in the capital market. Practical difficulties in identifying claimants to the net income of the firm, as well as the incentive problems of cost-based reimbursement, suggest that a competitive pricing approach is likely to be the appropriate means to provide a reasonable return on equity for the not-for-profit and the for-profit hospital. Implications of the analysis for the correct discount rate in investment decisions are outlined.