Electronic Theses and Dissertations





Date of Award


Document Type


Degree Name

Doctor of Business Admin


Business Administration



Committee Chair

Carolyn M. Callahan

Committee Member

James Lukawitz

Committee Member

John Malloy

Committee Member

David A Rosenthal


On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA). This three-part dissertation examines the effects the PPACA could have on the healthcare industry when fully implemented, particularly as it applies to both nonprofit and for-profit hospitals. The first dissertation paper examines both the usefulness of earnings quality for nonprofit hospitals and the effect on donations of such information. The research uses an adapted version of the Penman and Zhang (2002) quality score to determine whether accrual estimates in nonprofit hospitals' third-party reserve accounts and accompanying changes in investments are related to the quality of earnings and whether the adapted quality earnings scores are associated with unrestricted donations. The results indicate that earnings of nonprofit hospitals are affected by discretionary accruals, resulting in reduced-quality earnings. However, there is a significant positive relationship between the lower quality earnings and contributions suggesting that donors are misinformed by the misleading impact on earnings quality in this regard. The second dissertation paper examines the market reaction to the passage of the PPACA. Based on a timeline of events surrounding the passage of the PPACA, three dates are examined for 'abnormal' capital market behavior: (a) Senate Majority Leader Reid's letter to Senate Minority Leader McConnell on March 11, 2010, (b) the signing of the law by President Obama on March 21, 2010, and (c) the Supreme Court upholding of the constitutionality of the PPACA on June 28, 2012. The results indicate that both the Harry Reid letter and the passage of the bill positively impacted the market. The third dissertation paper sonsiders whether the quality of healthcare that a hospital provides is associated with cost efficiency and profitability and, if this relationship exists, whether it varies between for-profit and nonprofit hospitals. This study explores empirically whether high quality hospitals are also those that are operationally efficient. Quality is measured using metrics designed to proxy the actual quality metrics defined by the PPACA and to be used in determining hospital payments. The study finds that a relationship does exist between the quality of healthcare and both cost efficiency and profitability.


Data is provided by the student.

Library Comment

dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.