Zare Hossein, Anderson Gerard
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and School of Business, University of Maryland Global Campus, Adelphi, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Healthc Manag. 2024;69(6):439-454. doi: 10.1097/JHM-D-24-00080. Epub 2024 Nov 14.
This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values.
Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features.
Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits.
Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.
本研究旨在比较各类非营利性医院的免税价值和社区福利价值，并展示医院及地理特征如何解释这些价值。
利用2017年至2021年美国国税局990表格中的数据，评估非营利性医院的17种社区福利类型，并评估六类税收优惠。描述性分析在考虑教学状况、地理位置（农村或城市）及美国地区差异的情况下，比较非营利性医院之间的慈善医疗、社区福利及估计免税情况。此外，随机效应回归分析（包括未调整和调整后的分析）探究了社区福利与支出比率和一系列医院及地理特征之间的联系。
2017年至2021年期间，非营利性医院平均将其总支出的8.8%用于17种社区福利类型，其中1.8%用于慈善医疗；5.2%受益于免税。非营利性医院之间存在显著差异，24.0%的医院获得了比其社区福利支出更多的税收优惠，81.0%的医院获得的税收优惠超过了其慈善医疗支出。非营利性医院的特征和地理位置影响了社区福利的提供和构成。教学医院在社区福利总支出中所占比例高于非教学医院（9.2%对8.6%）。教学医院的前三大类别是医疗补助缺口、慈善医疗和未报销教育费用，而非教学医院除医疗补助缺口外，更侧重于慈善医疗和补贴医疗服务。此外，非营利性医院的地理位置影响了社区福利的分配。农村医院优先考虑医疗补助缺口、补贴医疗服务和慈善医疗，而城市医院则更集中于医疗补助缺口、慈善医疗和补贴医疗服务（按此顺序）。回归结果表明，系统隶属关系和位于美国南部地区是非营利性医院慈善医疗支出的正向预测因素。
联邦机构和各州对于获得税收优惠所需条件缺乏透明度和明确要求，导致非营利性医院的社区福利支出存在很大差异。一些医院获得的税收优惠多于其提供的社区福利，四分之三的非营利性医院获得的税收优惠超过了其慈善医疗支出。制定更明确的社区福利定义可以使所有非营利性医院更具问责性。
