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This study sheds light on the effects of policies that introduce competition into the marketplace of the provision of government services. The outcomes indicate that both nonprofit and government market share in a state are negatively affected by for-profit entry, a substitution relationship. The framing of the article in the New Public Management era and the Balanced Budget Act (BBA) of 1997 provides context in which to assess the policy consequences in hospice care. Given the budgetary challenges and growing cost of health care, this analysis begins a discussion of the effects of for-profit entry into the provision of government services, providing a glimpse into what the future holds for hospice care in the reforms of the Affordable Care Act (ACA) of 2010.
