Yeager Valerie A, Ferdinand Alva O, Menachemi Nir
1 Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
2 Texas A&M University School of Public Health, College Station, TX, USA.
Med Care Res Rev. 2019 Apr;76(2):167-183. doi: 10.1177/1077558717703215. Epub 2017 Apr 6.
The Internal Revenue Service (IRS) recently introduced tax code revisions requiring stricter oversight of community benefit activities (CBAs) conducted by tax-exempt, not-for-profit hospitals. We examine the impact of this tax requirement on CBAs among these hospitals relative to for-profit and government hospitals that were not subject to the new policy. We employed a quasi-experimental, difference-in-difference study design using a longitudinal observational approach and used secondary data collected by the American Hospital Association (years 2006-2010 including 20,538 hospital year observations). Findings show a significant increase in the reporting of 7 of the 13 CBAs among tax-exempt, not-for-profit hospitals compared with other hospitals after the policy change. Examples include partnering to conduct community health assessments ( b = 0.035, p = .002) and using capacity assessments to identify unmet community health needs ( b = 0.041, p = .001). Recent tax revisions are associated with increases in reported CBAs among tax-exempt, not-for-profit hospitals. As the debate continues regarding tax exemption status for not-for-profit hospitals, policy makers should expand efforts for enhanced accountability.
美国国税局（IRS）最近出台了税法修订案，要求对免税的非营利性医院开展的社区福利活动（CBA）进行更严格的监督。我们研究了这项税收要求对这些医院的社区福利活动的影响，并将其与未受新政策约束的营利性医院和政府医院进行对比。我们采用了准实验性的双重差分研究设计，运用纵向观察方法，并使用了美国医院协会收集的二手数据（2006 - 2010年，共20,538个医院年度观测值）。研究结果显示，政策变化后，与其他医院相比，免税的非营利性医院所开展的13项社区福利活动中有7项的报告数量显著增加。例如，合作开展社区健康评估（b = 0.035，p = 0.002）以及利用能力评估来确定未满足的社区健康需求（b = 0.041，p = 0.001）。最近的税收修订与免税的非营利性医院报告的社区福利活动增加有关。随着关于非营利性医院免税地位的争论仍在继续，政策制定者应加大力度提高问责制。
