Performance of public hospitals is difficult to define and measure because not only their managerial or financial performance but also their role as a public entity is important. The purpose of this paper is to examine the internal and external factors that influence the performance of local government hospitals. A multiple regression was performed to analyze the effects of the environmental, organizational, operational, and cost-related factors on the return on total assets(ROA), operating margin(OM), and the ratio of Medicaid patients. Empirical results show that financial performance (ROA and OM) are more influenced by operational or cost-related factors, while the ratio of Medicaid patients is more affected by environmental or organizational characteristics. It is noteworthy that competition and the contract with private sector management have negative effects on the ratio of Medicaid patients that local government hospitals treat.