More Money, More Problems? Implications of Excess Cash in Nonprofit Hospitals

Abstract

This study examines the implications of excess cash in nonprofit hospitals. Using a nationally representative sample of hospitals, I benchmark nonprofit cash holdings against for-profit cash holdings, and find that nonprofit hospitals hold significantly more cash. I consider three potential uses of excess cash in nonprofit hospitals: (a) investment in fixed assets, (b) increased charity care provision, and (c) higher executive compensation. I find that excess cash is associated with investments in fixed assets but not with increased charity care provision. Moreover, I find a positive relationship between excess cash and growth in CEO compensation. The results suggest that while nonprofit hospitals may accumulate cash to finance fixed assets, some of the accumulated cash may be diverted toward executive compensation. Overall, concerns regarding agency problems in nonprofit organizations may not be unfounded.