Oddleifson D August, Dong Huaying, Wadhera Rishi K
Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA.
Med Care. 2025 Mar 1;63(3):222-226. doi: 10.1097/MLR.0000000000002064. Epub 2024 Oct 2.
To assess the association between state policies and sociodemographic characteristics and state mean fair share spending at non-profit hospitals. Fair share spending is a hospital's charity care and community investment less the estimated value of their tax-exempt status.
Hospitals with non-profit status in the United States are exempt from paying taxes. In return, they are expected to provide community benefits by subsidizing medical care for those who cannot pay and investing in the health and social needs of their community.
We used a multivariable linear regression model to determine the association of state-level sociodemographics and policies with state-level mean fair share spending in 2019. Fair share spending data was obtained from the Lown Institute.
We found no association between the percentage of people living in poverty, in rural areas, or US region and fair share spending. Similarly, there was no association found for state minimum community benefit and reporting requirements. The state percentage of racial/ethnic minorities was associated with higher mean fair share spending [+$1.48 million for every 10% increase (95% CI: 0.01 to 2.96 million)]. Medicaid expansion status was associated with a 6.9-million-dollar decrease (95% CI: -10.4 to -3.3 million).
State-level community benefit policies have been ineffective at raising community benefit spending to levels comparable to the value of non-profit hospital tax-exempt status.
评估州政策与社会人口特征以及非营利性医院的州平均公平份额支出之间的关联。公平份额支出是指医院的慈善医疗和社区投资减去其免税地位的估计价值。
美国具有非营利地位的医院免征税款。作为回报，它们应通过补贴无力支付医疗费用者的医疗保健以及投资于社区的健康和社会需求来提供社区福利。
我们使用多变量线性回归模型来确定2019年州级社会人口统计学和政策与州级平均公平份额支出之间的关联。公平份额支出数据来自洛恩研究所。
我们发现生活在贫困地区、农村地区的人口百分比或美国地区与公平份额支出之间没有关联。同样，对于州最低社区福利和报告要求也未发现关联。种族/族裔少数群体在该州的百分比与更高的平均公平份额支出相关[每增加10%增加148万美元（95%置信区间：0.01至296万美元）]。医疗补助扩大状况与减少690万美元相关（95%置信区间：-1040至-330万美元）。
州级社区福利政策在将社区福利支出提高到与非营利性医院免税地位价值相当的水平方面一直没有成效。
