Seay J D
United Hospital Fund, New York City.
Health Prog. 1992 Jan-Feb;73(1):42-7.
Voluntary, not-for-profit hospitals are in danger of losing their tax-exempt status as policymakers lean toward stricter charity care requirements that would penalize hospitals which failed to provide at least a predetermined level of charity care. Proposed legislation abandons community benefit and advocates a relief-of-poverty standard. The relief-of-poverty standard advances the notion that hospitals are not providing enough charity care to merit their tax exemption. However, the voluntary hospitals' share of uncompensated care costs (as a percentage of total costs) increased from 70 percent in 1981 to 75 percent in 1989. The relief-of-poverty standard is inferior to the community benefit standard because it does not take into account that the character of community benefit varies among hospitals and communities. However, community benefit must be better defined. Some current activities--individual hospital reassessments, collective hospital reassessments, voluntary development of criteria, and statutory standards--will be instructive in efforts to arrive at a definition of community benefit that is appropriate for the specific community. Leaders in voluntary, not-for-profit hospitals need to develop positive and equitable criteria for hospital tax exemption. These hospitals' accountability is in question, but it is their integrity that is at stake.
随着政策制定者倾向于制定更严格的慈善医疗要求，对未能提供至少预定水平慈善医疗的医院进行处罚，自愿性非营利医院面临失去其免税地位的风险。拟议的立法摒弃了社区福利概念，并倡导采用扶贫标准。扶贫标准提出了这样一种观点，即医院提供的慈善医疗不足，不应享有免税待遇。然而，自愿性医院承担的未补偿医疗费用份额（占总成本的百分比）从1981年的70%增至1989年的75%。扶贫标准不如社区福利标准，因为它没有考虑到社区福利的性质在不同医院和社区之间存在差异。然而，必须对社区福利作出更明确的界定。当前的一些活动——个别医院重新评估、集体医院重新评估、自愿制定标准以及法定标准——将有助于努力得出适合特定社区的社区福利定义。自愿性非营利医院的领导者需要为医院免税制定积极且公平的标准。这些医院的问责性受到质疑，但事关重大的是它们的诚信。
