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Restoring Public Legitimacy to the Nonprofit Sector: A Survey Experiment Using Descriptions of Nonprofit Ownership
Mark Schlesinger
Yale and Rutgers Universities
Shannon Mitchell
Yale University and the New York Academy of Medicine
Bradford H. Gray
New York Academy of Medicine
The authors argue that declining legitimacy of the nonprofit sector in American society can be traced to a limited public understanding of nonprofit enterprise. In this article, they explore the nature and correlates of ownership-related expectations in medical care. Data from a new national survey document that most Americans believe that ownership affects medical care. However, about a third of the public does not understand ownership; those who do not have decidedly less favorable attitudes toward nonprofits. Expectations for nonprofits are more positive among those who feel vulnerable to bad outcomes in medical care, but are substantially more negative among minority groups. Using an experimental design incorporated into the survey, the authors demonstrate that having additional information about ownership improves expectations about nonprofit performance but to varying degrees, depending on the content of the explanation, the particular dimension of performance, and the level of prior understanding.
Key Words: nonprofit • for-profit • medical care • public opinion • trustworthiness
References
- Anheier, H., & Ben-Ner, A. (Eds.) (2003). The study of nonprofit enterprise: Theories and approaches. New York: Kluwer Academic/Plenum.
- Bloche, M. G. (1998). Should government intervene to protect nonprofits? Health Affairs, 17, 7-25.[Medline]
[Order article via Infotrieve]
- Brody, E. (2002). Accountability and public trust. In L. Salamon (Ed.), The state of nonprofit America (pp. 471-498). Washington, DC: Brookings Institution Press.
- Clarke, L., & Estes, C. (1992). Sociological and economic theories of markets and nonprofits: Evidence from home health organizations. American Journal of Sociology, 97, 945-969.[CrossRef]
- Diaz, W. (2002). For whom and for what? The contributions of the nonprofit sector. In L. Salamon (Ed.), The state of nonprofit America (pp. 517-536). Washington, DC: Brookings Institution Press.
- DiMaggio, P. J., & Anheier, H. K. (1990). The sociology of nonprofit organizations and sectors. Annual Review of Sociology, 16, 137-159.[CrossRef][Web of Science]
- Dundjerski, M. (1999, November 4). Nonprofit officials admit weakness in leadership. Chronicle of Philanthropy, p. 6.
- Fleishman, J. L. (1999). Public trust in not-for-profit organizations and the need for regulatory reform. In C. T. Clotfelter and T. Erlich (Eds.), Philanthropy and the nonprofit sector in a changing America (pp. 172-197). Bloomington: Indiana University Press.
- Gray, B. H. (1991). The profit motive and patient care: The changing accountability of doctors and hospitals. Cambridge, MA: Harvard University Press.
- Gray, B. H. (1997). Conversion of HMOs and hospitals: What’s at stake? Health Affairs, 16, 29-47.[Abstract]
- Gray, B. H. (1999). The changing face of health care. In C. T. Clotfelter and T. Erlich (Eds.), Philanthropy and the nonprofit sector in a changing America (pp. 364-384). Bloomington: Indiana University Press.
- Gray, B. H., & Schlesinger, M. (2002). Health. In L. Salamon (Ed.), The state of nonprofit America (pp. 65-106). Washington, DC: Brookings Institution Press.
- Hall, M. A., Dugan, E.Zheng, B., & Mishra, A. K. (2001). Trust in physicians and medical institutions: What is it, can it be measured, and does it matter? Milbank Quarterly, 79, 613-639.
- Hansmann, H. B. (1980). The role of nonprofit enterprise. Yale Law Journal, 89, 835-890.[CrossRef][Web of Science]
- Hirth, R. A. (1997). Competition between for-profit and nonprofit health care providers: Can it help achieve social goals? Medical Care Research and Review, 54, 414-438.[Abstract/Free Full Text]
- Holtmann, A., & Ullmann, S. G. (1993). Transaction costs, uncertainty and not-for-profit organizations: The case of nursing homes. In A. Ben-Ner & B. Gui (Eds.), The nonprofit sector in the mixed economy (pp. 149-159). Ann Arbor: University of Michigan Press.
- Hoy, E. W., Curtis, R., & Rice, T. (1991). Change and growth in managed care. Health Affairs, 10, 18-36.[CrossRef][Medline]
[Order article via Infotrieve]
- Institute of Medicine. (2000a). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
- Institute of Medicine. (2000b). To err is human: Building a safer health system. Washington, DC: National Academy Press.
- Institute of Medicine. (2002). Leadership by example: Coordinating government roles in improving health care quality. Washington, DC: National Academy Press.
- Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academy Press.
- Kaiser Family Foundation. (2003, July/August). Public opinion on medical errors. Kaiser Health Poll Report. Menlo Park, CA: Author.
- Keirouz, K. (1998). Public perceptions and confidence in Indiana nonprofit organizations. Indianapolis: Indiana University Center on Philanthropy.
- Kingma, B. (2003). Public good theories of the nonprofit sector. In H. Anheier & A. Ben-Ner (Eds.), The study of nonprofit enterprise: Theories and approaches (pp.53-66). New York: Kluwer Academic/Plenum.
- Kramer, R. M. (2000). A third sector in the third millennium? Voluntas, 11, 1-23.
- Krashinsky, M. (1997). Stakeholder theories of the nonprofit sector: One cut at the economic literature. Voluntas, 8, 149-162.
- Light, P. C. (2002). Pathways to nonprofit excellence Washington, DC: Brookings Institution Press.
- Lipman, H. (2001, July 26). Senator seeks review to find out whether charities defraud taxpayers. Chronicle of Philanthropy, p. 31.
- Miller, T. E., & Horowitz, C. R. (2000). Disclosing doctors’ incentives: Will consumers understand and value the information? Health Affairs, 19, 149-155.[Medline]
[Order article via Infotrieve]
- Norton, E. C., & Staiger, D. O. (1994). How hospital ownership affects access to care for the uninsured. Rand Journal of Economics, 25, 171-185.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Ortmann, A., & Schlesinger, M. (1997). Trust, repute and the role of nonprofit enterprise. Voluntas, 8, 97-119.
- Pauly, M. V. (1996). Health systems ownership: Can regulation preserve community benefits? Frontiers of Health Services Management, 12, 3-34.[Medline]
[Order article via Infotrieve]
- Powell, W. W., & Owens-Smith, J. (1998). Universities as creators and retailers of intellectual property: Life-sciences research and commercial development. In B. A. Weisbrod (Ed.), To profit or not to profit: The commercial transformation of the nonprofit sector (pp. 169-194). New York: Cambridge University Press.
- Powell, W. W., & Steinberg, R. (Eds.). (in press). The nonprofit sector: A research handbook (2nd ed). New Haven: Yale University Press.
- Rose-Ackerman, S. (1996). Altruism, nonprofits, and economic theory. Journal of Economic Literature, 34(2), 701-728.[Web of Science]
- Rothman, A., & Salovey, P. (1997). Shaping perceptions to motivate heath behavior: The role of message framing. Psychological Bulletin, 121(1), 3-19.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Salamon, L. M. (2002). The resilient sector: The state of nonprofit America. In L. Salamon (Ed.), The state of nonprofit America (pp. 3-63). Washington, DC: Brookings Institution Press.
- Salkever, D. S., & Frank, R. G. (1992). Health services. In C. S. Clotfelter (Ed.), Who benefits from the nonprofit sector (pp. 24-54). Chicago: University of Chicago Press.
- Sargeant, A., & Lee, S. (2002). Improving public trust in the voluntary sector: An empirical analysis. International Journal of Nonprofit and Voluntary Sector Marketing, 7(1), 68-83.[CrossRef]
- Schlesinger, M. (2002). On values and democratic policymaking: The fragile consensus around market-oriented medical care & #61504. Journal of Health Politics, Policy and Law, 27(6), 889-892.[Abstract]
- Schlesinger M., Dorwart, R. A., Hoover, C., & Epstein, S. (1997). The determinants of dumping: A national study of economically motivated transfers involving mental health care. Health Services Research, 32(5), 561-590.[Web of Science][Medline]
[Order article via Infotrieve]
- Schlesinger, M., & Gray, B. (in press). Nonprofit organizations and health care: The paradox of persistent attention. In W. W. Powell & R. Steinberg (Eds.), The nonprofit sector: A research handbook (2nd ed.). New Haven, CT: Yale University Press.
- Schlesinger, M., Gray, B. H., & Bradley, E. (1996). Charity and community: The role of nonprofit ownership in a managed health care system. Journal of Health Politics, Policy and Law, 21, 697-752.
- Schlesinger, M., Mitchell, S., & Gray, B. (in press). Public expectations of nonprofit and for-profit ownership in American medicine: Clarifications and implications. Health Affairs.
- Schneider, E., Cleary, P., Zaslavsky, A., & Epstein, A. (2001). Racial disparity in influenza vaccination: Does managed care narrow the gap between African Americans and Whites? Journal of the American Medical Association, 286(12), 1455-1460.[Abstract/Free Full Text]
- Smith, S. (2002). Social services. In L. Salamon (Ed.), The state of nonprofit America (pp. 148-186). Washington, DC: Brookings Institution Press.
- Smith, S., & Lipsky, M. (1993). Nonprofits for hire: The welfare state in the age of contracting. Cambridge, MA: Harvard University Press.
- Srinivasan, S. (1998). For-profit health care companies: Trends and issues. Menlo Park, CA: Kaiser Family Foundation.
- Steinberg, R. (1997). Overall evaluation of economic theories. Voluntas, 8(2), 179-204.[CrossRef]
- Stevens, R. (1982). A poor sort of memory: Voluntary hospitals and the government before the Depression. Milbank Memorial Fund Quarterly, 60, 551-584.[CrossRef]
- Sullivan, T. J., & Karlin, B. E. (1999). State community benefit needs assessment, planning and reporting laws. Tax Exempt Organization Tax Review, 23, 285-292.
- Tonkiss, F., & Passey, A. (1999). Trust, confidence and voluntary organizations. Sociology, 33(2), 257-274.[Abstract/Free Full Text]
- Toppe, C., & Kirsh, A. D. (2003). Keeping the trust: Confidence in charitable organizations in an age of scrutiny. Washington, DC: Independent Sector.
- Van Til, J. (1998). Twilight of nonprofits? Do hospital buyouts expose the writing on the wall? Non-Profit Times, 12, 57-58, 60, 65.
- Weisbrod, B. A. (1998). Conclusion and public policy issues: Commercialism and the road ahead. In B. A. Weisbrod (Ed.), To profit or not to profit: The commercial transformation of the nonprofit sector (pp. 287-305). New York: Cambridge University Press.
- Wilson, M., & Hegarty, N. (1997). Public perceptions of nonprofit organizations in Michigan. State of the state survey Lansing, MI: Institute for Public Policy and Social Research.
Nonprofit and Voluntary Sector Quarterly, Vol. 33, No. 4,
673-710 (2004)
DOI: 10.1177/0899764004269431
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