Sigmond R, Seay J D
J Health Adm Educ. 1994 Summer;12(3):259-68.
Health care reform has again focused the issues of ownership and mission of organizations in the health care field. Some believe that universal entitlement will eventually make both charitable patient care and the nonprofit form of organization obsolete. Others believe that special treatment of nonprofit organizations does not depend on charity at all; rather that the nonprofit form has social value in and of itself. The authors reflect a different point of view. They suggest that with reform, community benefit as the modern expression of a charitable mission will become ever more important in achieving the nation's health care goals. They believe that nonprofit organizations will continue to be entitled to special treatment only if their missions and programs extend beyond care of patients and entitled populations to focus also on care of communities. Any health organization's investment in disciplined community initiatives encompasses all the people in targeted communities, including those served by competing organizations. Without tax exemption, an organization committed to community care initiatives will be at a competitive disadvantage under the proposed community rated capitation payment system. Rather than abandoning the community benefit standard for tax exemption, health care reform calls for more systematic management of community care initiatives by nonprofit organizations and also of tax-exemption eligibility by the IRS.
医疗保健改革再次聚焦于医疗保健领域组织的所有权和使命问题。一些人认为，全民医保最终将使慈善性患者护理和非营利组织形式过时。另一些人则认为，非营利组织的特殊待遇根本不取决于慈善；相反，非营利组织形式本身就具有社会价值。作者们反映了一种不同的观点。他们认为，随着改革的推进，作为慈善使命现代体现的社区福利在实现国家医疗保健目标方面将变得更加重要。他们认为，只有当非营利组织的使命和项目超越对患者和应享待遇人群的护理，还关注社区护理时，它们才会继续有权获得特殊待遇。任何健康组织对有纪律的社区倡议的投资都涵盖目标社区的所有人，包括那些由竞争组织服务的人群。如果没有免税待遇，在拟议的社区评级按人头付费制度下，致力于社区护理倡议的组织将处于竞争劣势。医疗保健改革并非要求放弃免税的社区福利标准，而是要求非营利组织对社区护理倡议进行更系统的管理，同时美国国税局对免税资格进行更系统的管理。
