Potter M A, Longest B B
University of Pittsburgh.
J Health Polit Policy Law. 1994 Summer;19(2):393-419; discussion 421-2. doi: 10.1215/03616878-19-2-393.
Nonprofit hospitals have traditionally enjoyed charitable exemption from real estate taxes because they provide specific social benefits. However, in the past three decades, major health policy changes at the federal level--most significantly, implementation of the Medicare and Medicaid programs--have weakened this rationale. Federal tax regulations during this period have changed in ways that complement these federal health programs and the accompanying federal interests in encouraging efficiency and performance uniformity among hospitals. States and local governments, however, have different interests, and these may favor a strict set of tax exemption standards that disregard efficiency and elevate the importance of a measurable level of charitable service. Their divergent policies rest on a fundamental value judgment about whether nonprofit hospital care is intrinsically charitable or not. Increasingly, this judgment may be forced upon state courts and legislation by local governments seeking new tax revenues through the elimination of hospitals' exemption from real estate taxes.
非营利性医院传统上一直享有房地产税的慈善豁免权，因为它们提供特定的社会福利。然而，在过去三十年里，联邦层面的重大卫生政策变化——最显著的是医疗保险和医疗补助计划的实施——削弱了这一理由。在此期间，联邦税收法规的变化方式与这些联邦卫生计划以及联邦在鼓励医院提高效率和实现绩效统一方面的利益相辅相成。然而，州和地方政府有着不同的利益，这些利益可能倾向于一套严格的免税标准，即忽视效率并提升可衡量的慈善服务水平的重要性。它们不同的政策基于一个关于非营利性医院护理本质上是否具有慈善性质的基本价值判断。越来越多的情况是，地方政府通过取消医院的房地产税豁免权来寻求新的税收收入，这可能会迫使州法院和立法机构做出这种判断。
