A comparative study on the financial performance of hospitals by establishment type

Purpose This study examines whether hospital establishment type conditions the relationship between strategic priorities and financial performance. It compares public hospitals, university hospitals, medical corporations and foundation hospitals and identifies which strategic priority is most closely associated with profitability, stability and growth within each type. Design/methodology/approach Financial data for Korean hospitals from 2016–2022 are combined with text-mined 2022 director messages. TF-IDF identifies the salience of four Balanced Scorecard-based priorities – public orientation, patient focus, internal processes, and learning and growth – and establishment-type-specific regressions relate these priorities to return on assets (ROA), leverage (LEV) and sales growth (GRW). Findings No single priority is financially effective across all hospital types. In public hospitals, public orientation and patient focus are positively associated with profitability, while patient focus and learning and growth are positively associated with growth. University hospitals show patient focus for profitability, internal processes for stability, and learning and growth for growth; medical corporations show patient focus for profitability, public orientation for lower leverage and learning and growth for growth; and foundations show internal processes for profitability, public orientation for lower leverage, and learning and growth for growth. Originality/value The study integrates text-derived strategic priorities with conventional financial indicators and treats establishment type as an organizational boundary condition. Drawing on strategic choice, institutional and resource dependence perspectives, it explains why the financial relevance of strategic priorities varies systematically across hospital types.