Preserving the public interest when nonprofit hospitals merge or convert to for -profit: The federal and state regulatory role and a case study of Pennsylvania

This dissertation examines the public's interests in charitable assets, access to health care and health care costs affected by nonprofit hospital mergers and conversions. The analysis draws on case studies of health care mergers and conversions, particularly in Pennsylvania, to illustrate how government regulators exercise their authority to protect the public's interests when hospitals merge or convert.;Chapter I develops the problem: How to Protect the Public's Interests When Nonprofit Hospitals Merge or Convert. This chapter presents trends in hospital mergers and conversions for the nation and Pennsylvania and discusses reasons for their occurrence. It notes the dominant and increasing role state attorneys general play in protecting the public's interests in charitable assets, access to health care and consumer protection.;Chapter II places regulation of hospital mergers and conversions within the historical context of American regulatory eras. It notes the importance of regulatory climate in determining regulatory legislation and enforcement.;Chapter III examines the public's interest in nonprofit hospitals and describes the legal challenges to nonprofit hospital tax-exemption, particularly in Pennsylvania. Chapter IV tells the story of the egregious abuses in Blues conversions and illustrates how public lobbying groups and state attorneys general protect the public's interest.;Chapter V looks specifically at the Allegheny Health Education and Research Foundation (AHERF) bankruptcy and its impact on the public's interest. This Chapter highlights Pennsylvania's effort to pass charitable asset legislation in the aftermath of the AHERF debacle.;Chapter VI uses case studies to show how mergers can strip access to health care when control moves from local communities or when Catholic and non-Catholic hospitals merge.;Chapters VII, VIII, and IX look at the federal and state regulatory role in maintaining competition. Chapter VII explains why and how hospital antitrust regulation has become increasingly a state function. Chapter VIII presents outcomes of recent federal hospital antitrust cases. Chapter IX presents case studies of Pennsylvania antitrust actions. Both show the increasing prominence of state attorneys general in hospital antitrust.;Chapter X probes the question of why antitrust enforcement is less successful than the protection of charitable assets. This chapter contains recommendations for changes for Pennsylvania.