Do non-profit nursing homes separate governance roles? The impact of size and ownership characteristics.

Separation between operational responsibilities and those of oversight is an important point of discussion in governance. Novel to the literature, this paper not only offers direct evidence on the degree of separation, but also shows its relationship with size (ceteris paribus efficiency prescribes that large organizations implement more separation) and ownership characteristics of non-profit institutions. Using a sample of Belgian (Flemish) nursing homes, we find that in private nursing homes this separation increases with size while this is not the case in public homes. We document that this lack in flexibility in governance practices explains the micro-monitoring in public institutions. We formulate policy implications and suggest solutions to create more flexibility and likely also better governance.