Nonprofit hospitals face structural as well as financial challenges: lessons from Massachusetts.

Like most nonprofit hospitals, those of Massachusetts are facing serious financial challenges. Although the immediate issue is the shortfall between revenues and expenses, the author finds that the real problems are systemic, evidenced by at least three structural impediments: uncompensated care, overuse of teaching hospitals, and an increasingly unattractive environment for the practice of medicine. Other states whose nonprofit hospitals face persistent financial difficulties may find it useful to consider whether (similar or different) structural impediments are also undermining the operating performance of their own hospitals.