Virginia Commonwealth University, USA.
J Health Polit Policy Law. 2010 Dec;35(6):999-1026. doi: 10.1215/03616878-2010-036.
The definition of hospital community benefits has been intensely debated for many years. Recently, consensus has developed about one group of activities being central to community benefits because of its focus on care for the poor and on needed community services for which any payments received are low relative to costs. Disagreements continue, however, about the treatment of bad debt expense and Medicare shortfalls. A recent revision of the Internal Revenue Service's Form 990 Schedule H, which is required of all nonprofit hospitals, highlights the agreed-on set of activities but does not dismiss the disputed items. Our study is the first to apply definitions used in the new IRS form to assess how conclusions about the adequacy of nonprofit hospital community benefits could be affected if bad debt expenses and Medicare shortfalls are included or excluded. Specifically, we examine 2005 financial data for California and Florida hospitals. Overall, we find that conclusions about community benefit adequacy are very different depending on which definition of community benefits is used. We provide thoughts on new directions for the current policy debate about the treatment of bad debts and Medicare shortfalls in light of these findings.
多年来，医院社区福利的定义一直备受争议。最近，由于其关注贫困人群的护理以及相对成本而言低付费的必要社区服务，人们对一组成为社区福利核心的活动达成了共识。然而，关于处理呆账费用和医疗保险不足的问题仍存在分歧。最近，美国国税局（IRS）对所有非营利性医院都要求填写的 990 表格 H 进行了修订，该修订突出了一组已达成共识的活动，但并未排除有争议的项目。我们的研究首次将新 IRS 表格中使用的定义应用于评估，如果包括或排除呆账费用和医疗保险不足，对非营利性医院社区福利充足性的结论可能会产生怎样的影响。具体来说，我们研究了加利福尼亚州和佛罗里达州医院 2005 年的财务数据。总的来说，我们发现，使用不同的社区福利定义，对社区福利充足性的结论会有很大的不同。鉴于这些发现，我们就当前关于呆账和医疗保险不足处理的政策辩论的新方向提供了一些想法。
