{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:52:50Z","timestamp":1782301970770,"version":"3.54.5"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>We investigate whether the membership of a non-profit hospital\u2019s CEO on its board of directors is associated with CEO pay and several measures of hospital performance, including price, operating margin, quality, and service to low-income patients. Although the consequences of CEO board membership for for-profit firms have been studied extensively, the consequences for non-profits in general, and non-profit hospitals in particular, have received less attention. Because most hospitals are non-profit and non-profit hospital prices have increased rapidly over the past 20\u2009years, this gap is important. We use regression models to estimate the association between various measures of hospital performance and CEO board membership, holding constant fixed effects denoting the hospital\u2019s county of location, hospital board size, and other hospital characteristics. We find a strong positive association between CEO board membership and non-profit hospital prices, operating margins, and CEO pay, with a weaker positive (negative) association between CEO board membership and quality (service to low-income patients). We conclude that non-profit hospitals\u2019 CEO board membership is likely associated with increases in agency costs due to a lack of separation between management and control.<\/jats:p>","DOI":"10.1177\/00469580251366975","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:53:53Z","timestamp":1756342433000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-Profit Hospital Governance, Conduct, and CEO Pay"],"prefix":"10.1177","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9852-8177","authenticated-orcid":false,"given":"Daniel P.","family":"Kessler","sequence":"first","affiliation":[{"name":"Stanford University and NBER, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9172-8173","authenticated-orcid":false,"given":"William","family":"Wygal","sequence":"additional","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfineco.2020.04.007"},{"key":"e_1_3_3_3_2","unstructured":"Spencer Stuart 2024 U.S. Spencer Stuart Board Index. 2024 https:\/\/www.spencerstuart.com\/-\/media\/2024\/09\/ssbi2024\/2024_us_spencer_stuart_board_index.pdf."},{"key":"e_1_3_3_4_2","first-page":"1","volume-title":"The Handbook of the Economics of Corporate Governance","author":"Hermalin BE","year":"2017","unstructured":"Hermalin BE, Weisbach MS, eds. Introduction: the study of corporate governance. In: The Handbook of the Economics of Corporate Governance. Vol. 1. Elsevier; 2017:1-15."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2307\/256667"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/467037"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01360"},{"key":"e_1_3_3_8_2","unstructured":"Authors\u2019 calculations using 2021 American Hospital Association (AHA). Survey available for purchase from the AHA https:\/\/www.ahadata.com\/aha-annual-survey-database"},{"key":"e_1_3_3_9_2","unstructured":"Perry MJ. Chart of the day.\u2004.\u2004.or century? July 23 2022. https:\/\/www.aei.org\/carpe-diem\/chart-of-the-day-or-century-8\/"},{"issue":"11","key":"e_1_3_3_10_2","first-page":"1","article-title":"Commercial inpatient hospital price growth driven by system affiliation and nonprofit-status hospitals","volume":"2","author":"Chang JY","year":"2024","unstructured":"Chang JY, Martin K. Commercial inpatient hospital price growth driven by system affiliation and nonprofit-status hospitals. Heal Aff Sch. 2024;2(11):1-5.","journal-title":"Heal Aff Sch"},{"key":"e_1_3_3_11_2","doi-asserted-by":"crossref","unstructured":"Brot-Goldberg Z Cooper Z Craig SV Klarnet LR Lurie I Miller CL. Who pays for rising health care prices? Evidence from hospital mergers 2024 NBER Working Paper 32613. 2024.","DOI":"10.3386\/w32613"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jebo.2010.06.008"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0149206313503013"},{"key":"e_1_3_3_14_2","first-page":"291","article-title":"Boards, and the directors who sit on them","volume":"1","author":"Adams RB","year":"2017","unstructured":"Adams RB. Boards, and the directors who sit on them. In: Hermalin B, Weisbach M, eds. The Handbook of the Economics of Corporate Governance. Vol. 1. Elsevier; 2017: 291-382.","journal-title":"The Handbook of the Economics of Corporate Governance"},{"issue":"3","key":"e_1_3_3_15_2","first-page":"7","article-title":"The effects of CEO-board relations on hospital performance","volume":"22","author":"Molinari C","year":"1997","unstructured":"Molinari C, Hendryx M, Goodstein J. The effects of CEO-board relations on hospital performance. Health Care Manage Rev. 1997;22(3):7-15.","journal-title":"Health Care Manage Rev"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2006.00466.x"},{"issue":"6","key":"e_1_3_3_17_2","first-page":"429","article-title":"Management involvement on the board of directors and hospital financial performance","volume":"59","author":"Collum T","year":"2014","unstructured":"Collum T, Menachemi N, Kilgore M, Weech-Maldonado R. Management involvement on the board of directors and hospital financial performance. J Healthc Risk Manag. 2014;59(6):429-445.","journal-title":"J Healthc Risk Manag"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10551-012-1578-x"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.2308\/JOGNA-19-004"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2009.0297"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1282"},{"key":"e_1_3_3_22_2","first-page":"383","article-title":"Executive compensation: a survey of theory and evidence","volume":"1","author":"Edmans A","year":"2017","unstructured":"Edmans A, Gabaix X, Jenter D. Executive compensation: a survey of theory and evidence. In: Hermalin B, Weisbach M, eds. The Handbook of the Economics of Corporate Governance. Vol. 1. Elsevier; 2017:383-539.","journal-title":"The Handbook of the Economics of Corporate Governance"},{"key":"e_1_3_3_23_2","doi-asserted-by":"crossref","unstructured":"Babenko I Bennett B Sen R. Regulating CEO pay: evidence from the nonprofit revitalization act. September 15 2021. https:\/\/www.thenonprofittimes.com\/wp-content\/uploads\/2021\/09\/Regulating-CEO-pay-Evidence-from-Nonprofit-Revitalization-Act.pdf","DOI":"10.2139\/ssrn.3777576"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcorpfin.2014.12.016"},{"key":"e_1_3_3_25_2","unstructured":"IRS. 2025. https:\/\/www.irs.gov\/charities-non-profits\/form-990-series-downloads."},{"key":"e_1_3_3_26_2","unstructured":"RTI International. Community benefit insight [Data retrieval tool]. 2025. https:\/\/www.communitybenefitinsight.org\/"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/1077558718754573"},{"key":"e_1_3_3_28_2","volume-title":"National Health Care Governance Survey Report 2019","author":"American Hospital Association","year":"2022","unstructured":"American Hospital Association. National Health Care Governance Survey Report 2019. American Hospital Association; 2022."},{"key":"e_1_3_3_29_2","unstructured":"The AHA NHCGS is available for purchase from the American Hospital Association. American Hospital Association. 2025. https:\/\/www.ahadata.com\/aha-national-health-care-governance-survey."},{"key":"e_1_3_3_30_2","unstructured":"The AHA Hospital Survey is available for purchase from the American Hospital Association. American Hospital Association. 2025. https:\/\/www.ahadata.com\/aha-annual-survey-database."},{"key":"e_1_3_3_31_2","unstructured":"National Academy for State Health Policy. Hospital cost tool [Data retrieval tool]. 2025. https:\/\/tool.nashp.org\/"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00249"},{"key":"e_1_3_3_33_2","unstructured":"Respectively. https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/research_reports\/RRA1100\/RRA1144-2-v2\/RAND_RRA1144-3-v2.annex.zip July 2022 and https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/research_reports\/RRA1100\/RRA1144-1\/RAND_RRA1144-1.Supplemental_Materials.zip March 2025."},{"key":"e_1_3_3_34_2","unstructured":"Whalley CW Briscombe B Kerber R O\u2019Neill B Kofner A. Prices paid to hospitals by private health plans: findings from round 4 of an employer-led transparency initiative RAND 2022. https:\/\/www.rand.org\/pubs\/research_reports\/RRA1144-1.html."},{"key":"e_1_3_3_35_2","unstructured":"Whalley CW Kerber R Wang D Kofner A Briscombe B Prices paid to hospitals by private health plans: findings from round 4 of an employer-led transparency initiative. RAND. 2024. https:\/\/www.rand.org\/pubs\/research_reports\/RRA1144-2-v2.html."},{"key":"e_1_3_3_36_2","unstructured":"A detailed explanation of how the star ratings are constructed is available at: https:\/\/data.cms.gov\/provider-data\/topics\/hospitals\/overall-hospital-quality-star-rating 2025."},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1162\/rest_a_00804"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/qje\/qjy020"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1257\/pol.20130009"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0306571"},{"key":"e_1_3_3_41_2","unstructured":"Lewellen K Phillips G Sertsios G. Control without ownership: governance of nonprofit hospitals Working Paper. March 2023. https:\/\/haslam.utk.edu\/wp-content\/uploads\/2023\/04\/Lewellen-Nonprofit-Governance-LPS-March-24_2023.pdf"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0264712"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.5034\/inquiryjrnl_47.03.242"},{"key":"e_1_3_3_44_2","unstructured":"See Table 6 Column E of the spreadsheet. March 2025. https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/research_reports\/RRA1100\/RRA1144-2-v2\/RAND_RRA1144-3-v2.annex.zip."},{"key":"e_1_3_3_45_2","unstructured":"See Table 3 Columns B and E of the spreadsheet. March 2025. https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/research_reports\/RRA1100\/RRA1144-2-v2\/RAND_RRA1144-3-v2.annex.zip."},{"issue":"1","key":"e_1_3_3_46_2","article-title":"What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings","volume":"2","author":"Trenaman L","year":"2024","unstructured":"Trenaman L, Harrison M, Hoch JS. What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings. Heal Aff Sch. 2024;2(1):qxad085.","journal-title":"Heal Aff Sch"}],"updated-by":[{"DOI":"10.1177\/00469580261450809","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000}}],"container-title":["INQUIRY: The Journal of Health Care Organization, Provision, and Financing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00469580251366975","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00469580251366975","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00469580251366975","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:10:34Z","timestamp":1777461034000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00469580251366975"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":45,"alternative-id":["10.1177\/00469580251366975"],"URL":"https:\/\/doi.org\/10.1177\/00469580251366975","relation":{},"ISSN":["0046-9580","1945-7243"],"issn-type":[{"value":"0046-9580","type":"print"},{"value":"1945-7243","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"article-number":"00469580251366975"}}