Institutional Pressures to Provide Social Benefits and the Earnings Management Behavior of Nonprofits : Evidence from the US Hospital Industry

This study examines the relationship between institutional pressures to provide social benefits and the discretionary accrual behavior of nonprofit firms. I examine this issue within the context of US nonprofit hospitals, an economically significant and politically rich setting where firms face considerable institutional pressure to provide an important social benefit: charity care. I argue that institutional pressures on nonprofits to provide higher levels of social benefits imply that lower profits should be reported. I develop theory and provide evidence which suggests that, due to competing private incentives to report higher profits, nonprofit managers strategically use discretionary accruals to increase accounting earnings when the social benefits their firms have provided in the current period exceed external stakeholders' normative expectations. The findings from this study inform the ongoing political debate regarding the appropriateness of tax-exemptions for US nonprofit hospitals and should therefore be of interest to both regulators and policymakers. In addition, this study provides timely insights for researchers regarding how institutional pressures can affect managers' reporting behaviors in other settings where similar competing reporting incentives exist between managers' private benefits and stakeholder expectations related to social benefits