DNP 835 Topic 3 DQ 2: for-profit vs not-for-profit care
The intuition that not-for-profit means more ethical is widely shared and only partly supported. The evidence is messier than either side of the argument usually admits.
Editorial process
Last reviewed · August 15, 2026
Ownership is a tax status, not a moral one
Start with what the distinction actually is, because it is narrower than the moral weight attached to it. A not-for-profit hospital has no shareholders and cannot distribute a surplus; it must reinvest and, in exchange for tax exemption, provide community benefit. It can still run a surplus, pay large executive salaries, close unprofitable services and pursue lucrative ones. A for-profit hospital distributes surplus to owners and pays tax. That is the whole legal difference, and it plainly does not settle whether care is more ethical. Posts that treat not-for-profit as a synonym for mission-driven and for-profit as a synonym for extractive have imported a conclusion rather than argued one. It is worth noting how much of US hospital capacity sits in each category before arguing about either, since the not-for-profit share is far larger than the debate's tone usually suggests and the two sectors are not evenly distributed across regions or service lines.
The evidence rewards a careful reading. Comparative studies find differences in service mix, staffing and margins, and they are not uniformly flattering to either side; meanwhile the community-benefit obligation that justifies the tax exemption has repeatedly been found to be inconsistently measured and, in some analyses, worth less than the exemption itself. Governance research suggests board structure predicts performance more reliably than ownership label does. That points at the strongest available position: ownership sets the incentives an organisation faces, but what determines ethical care is closer to governance, transparency, staffing decisions and whether anyone is accountable for the population that cannot pay. Take a position — the prompt asks for one — but let it rest on a mechanism rather than on the label, and cite at least one study that complicates whichever side you land on. Say which outcome you are treating as the ethical one, since access, quality and cost do not move together.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01State accurately what distinguishes the two ownership models.
- 02Separate legal structure from ethical conduct.
- 03Read comparative evidence without importing a conclusion.
- 04Identify governance as a mediating factor.
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Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. 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A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. DNP 835 Topic 3 DQ 2 Two major models of care exist, for-profit and not-for-profit There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week. I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course! Name: Discussion Rubric Grid View List View Excellent 90–100 Good 80–89 Fair 70–79 Poor 0–69 Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Main Posting: Writing 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Posting: Timely and full participation 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date. 7 (7%) – 7 (7%) Posts main Discussion by due date. 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. First Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. First Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. First Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Second Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. Second Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Second Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Total Points: 100 Name: Discussion Rubric
Turn the brief into deliverables
- 01An accurate account of the legal and tax distinction.
- 02Evidence comparing the two on care or access.
- 03A stated position with a mechanism behind it.
- 04At least one source complicating your own position.
Define the difference, then test it against evidence
What actually differs
Set out the legal, tax and distribution differences precisely.
What the evidence compares
Report findings on service mix, staffing, access and margins.
Community benefit and the exemption
Examine what not-for-profit status is supposed to buy the public.
Your position and its mechanism
Take a stance grounded in governance and incentives.
Studies that compare the two directly
Recommended databases
- PubMed Central
- Health Affairs
- KFF
- CINAHL
Search sequence
- 1.Find a direct comparative study on outcomes or staffing by ownership.
- 2.Read one analysis of community benefit versus the value of the exemption.
- 3.Look for governance research that treats ownership as one variable among several.
- 4.Note a finding that cuts against the position you expect to take.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Comparing the Value of Nonprofit Hospitals' Tax Exemption to Their Community Benefits
Inquiry: The Journal of Health Care Organization, Provision, and Financing · 2018
Compares the value of nonprofit hospitals' tax exemption against the community benefits they provide, which is the exchange the ethical claim rests on.
- 02
Does governance matter? Board configuration and performance in not-for-profit hospitals
The Milbank Quarterly · 2006
Finds board configuration predicting performance in not-for-profit hospitals, which is the governance-over-ownership argument in evidence.
- 03
Evaluating hospitals' provision of community benefit: an argument for an outcome-based approach to nonprofit hospital tax exemption
American Journal of Public Health · 2013
Argues for outcome-based assessment of community benefit, which exposes how loosely the obligation is currently measured.
- 04
Health Costs - Research and Data from KFF
KFF · 2024
Cost and coverage data across ownership types, useful for testing claims about access rather than assuming them.
Review before submission
Common mistakes
- Treating not-for-profit as a guarantee of mission-driven behaviour.
- Assuming for-profit ownership necessarily degrades care.
- Answering with intuition and no comparative evidence.
- Ignoring the community-benefit obligation and how it is measured.
Submission checklist
- Is the legal distinction stated correctly?
- Have you cited comparative evidence rather than asserting?
- Does your position rest on a mechanism?
- Did you include something that cuts against your view?
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