Bloche M Gregg
Brookings Institution, Washington, DC, USA.
Health Aff (Millwood). 2006 Jul-Aug;25(4):W304-7. doi: 10.1377/hlthaff.25.w304. Epub 2006 Jun 20.
Defenders of tax preferences for nonprofit hospitals and health plans, including Mark Schlesinger and Brad Gray, contend that nonprofits deserve government support because they provide greater "community benefit" than their for-profit counterparts. This argument is unconvincing. There is some evidence that nonprofits deliver marginally more "community benefit" but no evidence that tax exemption is the cause. Absent proof that tax expenditures, including exemption, "buy" social benefits that are worth the cost to taxpayers, these expenditures are unjustified. The better course would be to pay nonprofits for performance, by tying tax benefits to accomplishments (beyond current achievements) in health promotion, quality, and care for the needy.
包括马克·施莱辛格和布拉德·格雷在内的非营利性医院和医疗计划税收优惠政策的支持者认为，非营利性机构值得政府支持，因为它们比营利性机构提供了更多的“社区福利”。这一论点并不令人信服。有证据表明非营利性机构略微提供了更多的“社区福利”，但没有证据表明免税是其原因。如果没有证据证明包括免税在内的税收支出“购买”了对纳税人来说物有所值的社会福利，那么这些支出就是不合理的。更好的做法是根据绩效向非营利性机构付款，将税收优惠与在健康促进、质量和贫困人群护理方面（超越当前成就）的成果挂钩。
