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Comparative Summary
Financial statements and policies are important to all organization and in health care it is a measurement to reflect how well the organization is operating. This paper will look at 3 types of organizations: Nonprofit, for profit and government hospitals and examine the financial structures and the unique policies in each environment. It is important to understand the similarities and difference to fully grasp the significances and differences within the health care community. The first organization to examine is not for profit healthcare organizations. Not for profit organizations governed by a board of trustees and a required to comply with federal and local laws and regulations regarding charitable donations and fiscal compliance. There are three major organization that issue financial standards for not for profit organizations to follow regarding here financial status. The organizations are the Financial Accounting Standards Board (FASB), the American Institute of Certified Public Accountants (AICPA), and the U.S. Federal Office of Management and Budget (OMB) (Mercer, 1999).
In order to maintain a not for profit status the organization must comply with the IRS reporting measures and provide. The rules with the IRS can be found under section 501(c)(3) of the Internal Revenue Code and is how an organization can be tax exempt. Beyond federal guidelines “many states require that contributions, gifts, grants, etc., and functional expenses be reported according to the AICPA industry audit guide, "Not-For-Profit Organizations," supplemented by the National Health Council's "Standards of Accounting and Financial Reporting for Voluntary Health and Welfare Organizations”(Mercer, 1999, para 8).
St. Jude’s Research Hospital is a not for profit healthcare organization that complies with the IRS code to qualify as a tax exempt status and also meets the 20 standards of Wise Giving Alliance Standards for Charity Accountability set forth by the Better Business Bureau. The total income for St. Jude through June 2010 was $1,051,623,909. Program expenses accounted for $609,030,506, Fund raising expenses $145,473,865, and Administrative expenses accounted for $80,240,961. This left an excess of $216,878,577. The financial summary includes fundraising expenses, operations expenses, program expenses, where the income was delivered, and excess that is left (Better Business Bureau, 2011).
Another type of organization is governmental hospitals like VA hospitals. “The major military health care programs are operated through the Department of Defense (DoD) and the Department of Veterans Affairs. The Department of Defense covers active duty service members and retirees from all branches of the military and their families while the Department of Veterans Affairs covers veterans and their eligible family members. Each program has different eligibility criteria, benefits packages, and financing structures” (Kaiser EDU, nd, para 1).
Financing the VA programs is done through congressional apportionments to the Depatment of Defense budgets. The government uses an HMO plan called Tricare and the Medicare Eligible Retiree Health Care Fund (MERHCF) which is funded also through congress. “The agency’s medical budget has doubled in the past decade, rising from $17 billion in 1996 to $36 billion in 2007, reflecting an annual compound growth rate of 7.4 percent in nominal terms (or 5.2 percent after accounting for inflation)” ( CBO, 2008, para 22).
Unlike for profit organizations and not for profit organizations, government funding is allocated to them and the government can support laws and regulations to help support their missions. Health care costs have risen in every arena but the VA organizations have been able to hold down some cost related to pharmaceuticals. “One factor enabling the VA to hold down its costs is the fact that federal law enables the department to purchase pharmaceutical products at prices that are less than those available to nearly any other purchaser. In addition, VA uses a restrictive formulary to reduce its pharmaceutical costs even further” (CBO, 2008, para 19). All of the monies like not for profit organizations are recycled back into the organization though usually there is a short fall.
For profit organizations like investor owned private and public hospitals as well as specialty hospitals are driven by profits. In order for investors to make an income the company must be profitable and they are provided with dividends. Income for the hospital comes from private insurance, public insurance, and personal out of pocket payments. One factor that not for profit and government hospitals does not have to monitor is bad debt, unpaid medical bills that can have an impact on the bottom line.
For profit health care entities accounting “Ratios that relate to capital structure indicates that equity financing and fixed-asset financing are strongly correlated and, thus, are meaningful for estimating a hospital's capital structure. Low values for equity financing and high values for fixed-asset financing imply more debt” (Zeller, Stanko, & Cleveley, 1997, Pg 2).
Working capital efficiency is important when looking at investments of current assets or working capital. “Analysis among the ratios that relate to working capital efficiency indicates that the current ratio, current asset turnover, and days cash on hand (short-term sources) are significantly correlated, which suggests that these financial ratios are meaningful for estimating a hospital's working capital efficiency” (Zeller, Stanko, & Cleveley, 1997, Pg 2).
The study did indicate that current ration should be viewed differently. Normally high values in the current ratio are a good sign but this study suggests the opposite may be true. “This makes economic sense given that the primary cause of high current ratios for most hospitals is excessive days in receivables. Excessive days in receivables is a clear indication of poor working capital efficiency” (Zeller, Stanko, & Cleveley, 1997, Pg 2).
When looking at hospitals as opposed to other industries it’s important to understand the impact that each accounting principle has on the type of organization, what each of the ratio’s and principles mean to understand how it actually impacts the outcome of the organization because the values are different in the healthcare industry. “The Study identified a meaningful set of financial that, when grouped together, summarize the financial position of a hospital and define a set of critical financial ratios that describe those common financial characteristics for most hospitals” (Zeller, Stanko, & Cleveley, 1997, pg 3).

References
Better Business Bureau, (2011), BBB Wise Giving Report for ALSAC/St. Judes Children’s Hospital, retrieved from website, http://www.bbb.org/charity-reviews/national/cancer/alsac-st-jude-childrens-research-hospital-in-memphis-tn-2903
CBO, (2008), The Health Care System for Veterans: An Interim Report, retrieved from website http://www.cbo.gov/ftpdocs/88xx/doc8892/maintext.3.1.shtml
Kaiser EDU, (nd), Military and Veterans Health Care, http://www.kaiseredu.org/Issue-Modules/Military-and-Veterans-Health-Care/Background-Brief.aspx
Mercer, E. (1999), Critical Issues in Financial Accounting Regulation for Nonprofit Organizations, Retrieved from website: http://www.muridae.com/nporegulation/accounting.html#fasb
Zeller, T.L., Stanko, B.B., Cleverley, W.O. (1997), A new perspective on hospital financial ratio analysis, FindArticles / Health / Healthcare Financial Management / Nov, 1997, retrieved from website: http://findarticles.com/p/articles/mi_m3257/is_n11_v51/ai_20446235/pg_2/

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