Auditor Type and Audit Quality Differences in Nonprofit Healthcare Organizations – U.S. Evidence

The purpose of this paper is to explore audit quality in nonprofit healthcare organizations by investigating differences in audit report outcomes. Specifically, we examine the relationship between auditor type and auditor-disclosed internal control exceptions in Circular A-133 audits of U.S. nonprofit healthcare organizations. Our findings indicate audits of nonprofit healthcare organizations conducted by the Big Four CPA firms carry a lower likelihood of disclosing internal control exceptions (i.e., reportable conditions and material weaknesses) than are audits conducted by smaller CPA firms. This challenges the general contention from prior studies that the Big Four firms are better audit quality providers and indicates that the alleged superiority of Big Four firms in terms of audit quality may not be generalizable to all industry sectors.Audit quality, Auditor type, Circular A-133, Nonprofit healthcare, Single Audit Act

Is The Community Health Needs Assessment Replacing the Certificate of Need?

The purpose of this paper is to question the need for Certificates of Need at the state level. At the Federal level the Affordable Care Act requires hospitals must justify their community impact through a Community Health Needs Assessment (IRS Form 990 Schedule H) in order to retain their tax-exempt status. Not-for-profit hospitals will save money, time and personnel resources if the CON is combined with the CHNA and all states accept this change, no longer requiring the CON

Global Outsourcing of Healthcare: A Medical Tourism Decision Model

The demand for global healthcare services is experiencing tremendous growth. US patients are seeking to reduce their expenditures on healthcare through obtaining treatment on an internationally competitive basis. This trend, known as medical tourism, is on the rise, and US legislators and policy makes must be aware of the issues facing American patients. This paper seeks to model factors that influence a patient's decision to seek healthcare services abroad. we develop a two-stage model for medical tourism- the first stage being the evaluation of the foreign country and the second stage choosing the healthcare facility. We argue country-specific characteristics influence the country of choice-including economic condition, political climate, and regulatory policies. We also argue that certain factors- including costs, hospital accreditaion, quality of care, and physician trining- impact the choice of healthcare facility. The model suggests that no one factor is dominant in the decision, but all play a crucial role in choosing healthcare on an international basis. Policy makers must use these factors to evaluate the impact medical tourism will continuw to have on the US healtcare system in order to effectively compete in today's global, consumer-driven healthcare market.Medical tourism; global outsourcing; decision model; health care system; healthcare services; health policy; health costs

Making Common Causes: Crises, Conflict, Creation, Conversations: Offerings from the Biennial ALECC Conference Queen’s University, Kingston 2016

At ALECC’s biennial gathering at Queen’s University in June 2016, participants came together to explore the possibilities of “making common causes” from a host of angles, yet all were anchored in an acknowledgement of the diverse more-than-human relationships that make up our common worlds. The following collection of short essays, authored by some of the gathering’s keynote speakers, explores specific aspects of making common causes. In this special section of The Goose, we deliberately invoke the plural of conversation. We understand the effort to make common causes as a process, rather than a “one and done” act. It is multifaceted and messy; it invites imagination and critique. Most importantly, it needs to cultivate the common ground whereupon these difficult conversations can be engaged

Non-equilibrium dynamics and floral trait interactions shape extant angiosperm diversity.

Why are some traits and trait combinations exceptionally common across the tree of life, whereas others are vanishingly rare? The distribution of trait diversity across a clade at any time depends on the ancestral state of the clade, the rate at which new phenotypes evolve, the differences in speciation and extinction rates across lineages, and whether an equilibrium has been reached. Here we examine the role of transition rates, differential diversification (speciation minus extinction) and non-equilibrium dynamics on the evolutionary history of angiosperms, a clade well known for the abundance of some trait combinations and the rarity of others. Our analysis reveals that three character states (corolla present, bilateral symmetry, reduced stamen number) act synergistically as a key innovation, doubling diversification rates for lineages in which this combination occurs. However, this combination is currently less common than predicted at equilibrium because the individual characters evolve infrequently. Simulations suggest that angiosperms will remain far from the equilibrium frequencies of character states well into the future. Such non-equilibrium dynamics may be common when major innovations evolve rarely, allowing lineages with ancestral forms to persist, and even outnumber those with diversification-enhancing states, for tens of millions of years

Public Health Service (PHS) Agencies: Overview and Funding, FY2010-FY2012

This report discusses the eleven agencies that consist of the Department of Health and Human Services (HHS), including their purposes and funding