Gentry William M
Graduate School of Business, Columbia University, New York NY 10027, USA.
J Health Econ. 2002 Sep;21(5):845-72. doi: 10.1016/s0167-6296(02)00056-5.
Not-for-profit hospitals benefit from special tax rules that allow state authorities to issue tax-exempt bonds on their behalf, which may affect their investment and financing choices. Hospitals may respond by increasing their investment in physical assets; however, they may also engage in tax arbitrage by using the tax-exempt debt while maintaining endowment assets. The paper combines data from tax (information) returns and the annual survey of hospitals by the American Hospital Association for 1993-1996. Overall, the results are consistent with substantial tax planning by not-for-profit hospitals. Of the US$ 55.9 billion in tax-exempt liabilities of hospitals in 1996, as much as US$ 32.6 billion could have been eliminated if hospitals spent their endowments instead of borrowing. Furthermore, controlling for hospital size (in terms of revenues and operating assets), endowment assets are associated with a higher ratio of tax-exempt (or total) debt to operating assets. In contrast, endowment assets are not related to taxable debt suggesting that the effects of the endowment on borrowing are motivated by tax incentives. Investment and endowment accumulation regressions suggest that increases in debt increase both physical investment and endowment accumulation but these effects are concentrated among cash-rich hospitals for which the effects on endowment accumulation effects are larger than the effects on physical investment.
非营利性医院受益于特殊的税收规定，这些规定允许州政府当局代表它们发行免税债券，这可能会影响它们的投资和融资选择。医院可能会通过增加对实物资产的投资来做出回应；然而，它们也可能通过使用免税债务同时维持捐赠资产来进行税收套利。本文结合了1993 - 1996年税收（信息）申报表数据以及美国医院协会对医院的年度调查数据。总体而言，结果与非营利性医院进行大量税收筹划的情况一致。在1996年医院559亿美元的免税债务中，如果医院动用捐赠基金而非借款，高达326亿美元本可避免。此外，在控制医院规模（按收入和运营资产衡量）的情况下，捐赠资产与免税（或总）债务与运营资产的比率较高相关。相比之下，捐赠资产与应税债务无关，这表明捐赠对借款的影响是由税收激励驱动的。投资和捐赠积累回归分析表明，债务增加会同时增加实物投资和捐赠积累，但这些影响集中在现金充裕的医院，对这些医院而言，对捐赠积累的影响大于对实物投资的影响。
