Introduction
While all of the entities have one singular purpose in mind, the delivery of quality healthcare services, the entities also are very different in many ways. In this paper I will give a description of what the financial structure is of each environment while looking at the policies that are unique to each one of the environments. This will be done while also looking at the prevailing financial management practices that are prevalent within the financial environments and why it is that effective financial management is so difficult inside the healthcare industry as opposed to other industries. Not for profit financial environment
Not for profit financial environment can simply be identified by their name and that they have a no profit motive. A prime example of a not for profit organization could be a clinic that is located in Marlin, Texas called the Falls Community Hospital and Clinic. This organization offers a cost effective health service to the residents of their town and is mandated to not make a profit but to only make enough yearly revenue to keep things running and to sustain the delivery of its health services.
When dealing with the financial structure of a not for profit organization it is key to understand that the ownership interest is not able to be transferred. Keeping this fact in mind, the most logical accounting for this type of financial environment would be fund accounting. With this case the main emphasis is put on resource accountability and according to Finkler (2006) when it comes to not for profits there is utilization of Differential GAAP, which stands for Generally Accepted Accounting Principles). In not for profit organizations they do not have to pay taxes but they do have to file for a tax exempt status. When dealing with the unique policies with a not for profit entity, it is key to understand that it is standard policy that a not for profit does not have any motive for profit and when it comes to the policies that there is a major emphasis that is put upon volunteer management. The reason for this is to make sure that most of the organizations undertakings are volunteer based because their services are delivered to the underserved and the minority populations. At the same time there are many different management practices that become prevalent in a not for profit organization that are unique due to the circumstances. Not for profit organizations have a unique source of revenues that include donations. Not for profit organizations often lack a cost/benefit relationship which can be taken to be direct and in such a case, the decision making and management concepts adopted in this case change as compared to those of for profits. According to Finkler (2006) there is no insistence on strategic management principles like competitiveness building when it comes to the financial management of non for profits.

For profit financial environments An example of a for profit financial environment would be the Health Management Associates Inc. that was founded in 1977 with the sole purpose of owning, leasing and managing hospitals within the United States in mind. Today HMA has done well to operate a total of fifty nine hospitals in fifteen different states while holding on to close to eighty eight hundred licensed beds. Health Management Associates is a for profit organization that have the three key features of investor owned organizations. First off you have the owners, the stockholders of the company, and they are well known to the public and this group of stockholders exercises control of the organization by voting for their directors. The second key feature would be that the residual earnings of the organization belong to the owners which in turn make management only responsible to the stockholders for whatever the profit of the firm may be. And finally the organization is subject to taxation by the local, state and federal levels. Health Management Associates has a vision that states they will lead the hospital industry in the quality section, clinical metrics, the outcome of their patients and the customer service areas. In 2011 Health Management Associates achieved a top tier in the hospital industry and customer satisfaction for patients, their doctors and their associates so it seems that they are on their way to leading. According to Campbell (2002) the challenges encountered as far as the effective financial management in healthcare is concerned is informed by decreasing revenues as well as costs that are seen to be increasing and the financial controls are important to for profit entities for purposes of reducing costs and hence increase profitability. The continue rising costs in the healthcare industry has continue to pass other industries by and many analysts project that sometime within the next few years people who are in the healthcare industry may have to undertake some major cost cutting measures in order to keep their organizations afloat. At the same time healthcare organizations have to ensure that the amount of cost that their services that they offer is not prohibitive because unlike other organizations out there the healthcare industry is unable to arbitrarily increase the cost of their services. Due to this there is a lot of difficulty when trying to find the correct balance between the delivery of quality services and the affordability of the services that are offered.

Government Government entities are like the not for profit entities because they do not usually have a profit motive and in their case the use of fund accounting is also recommended. A prime example of a government environment entity would be the Veterans Affair Hospital located in Lexington, KY. It concerns itself with the well-being and proper medical treatment to veterans. In regards to the financial structure of a government entity Contino (2002) states that “there is a sustained use of modified accrual which in this case can be made up of budget entries, expenditures as well as revenues”. Governments utilize fund accounting and there are a few funds that have been put in place to help organizations. The funds that they receive are vital in the structure of government entities financials. The polices are unique when it comes to the government environment and according to Campbell (1998) there is a great need to make sure that the organizations budget properly in that kind of environment. Additional funding is used to meet the difference in the actual cost and the budgets of a government entity and this is normally met by the government with taxes. There also may be a restriction of operations financially when dealing with financial management practices and this is one of the major fund accounting reasons. When it comes to the government organizations there is a massive need to have financial reporting so that the actual cost and the budgeted cost can be compared as well as for legal compliance.

Conclusion It is vital to understand that despite the differences between for-profit, not for profit and the government environments there exist some rather unique similarities. With all three of these environments there has to be a sound financial practice to run these organizations. With all three of these environments they are united in one purpose and that is to offer quality service for their customers.

References Campbell, C., Schmitz, H. & Waller, L. (1998). Financial management in a managed care environment. Albany, NY: Delmar Publishers Contino, D. (2002, August). Breaking even: How low can you go? Nursing Management, 33(8), 11. Finkler, S. A. & Ward, D. M. (2006). Accounting Fundamentals for Health Care Management. Jones and Barlett Publishers, Inc.