Hospital Charity Care — Effects of New Community-Benefit Requirements

2015 ◽  
Vol 373 (18) ◽  
pp. 1687-1690 ◽  
Author(s):  
Sayeh S. Nikpay ◽  
John Z. Ayanian
Author(s):  
Bradford H. Gray ◽  
Mark Schlesinger

Under Internal Revenue Service requirements, nonprofit hospitals will begin filing new community benefit reports in 2010. Maryland has had similar requirements since 2004. This paper, based on interviews at 20 hospitals, describes how Maryland's requirements affected hospitals and their activities. Increases in reported community benefit expenditures since the program began are due to both changes in activities and better data capture. Charity care accounts for one-third of community benefit dollars. A key distinction concerns whether hospitals take an accounting or managerial approach to community benefit. The Maryland experience suggests the issues that will arise when the national requirements are implemented.


2020 ◽  
Vol 110 (4) ◽  
pp. 492-498 ◽  
Author(s):  
Christopher W. Goodman ◽  
Amber Flanigan ◽  
Janice C. Probst ◽  
Allan S. Brett

Objectives. To examine content of financial assistance polices (FAPs) among US tax-exempt hospitals and determine whether restrictive policies were associated with reduced charity care spending. Methods. Using hospital tax filings with the Internal Revenue Service in 2016 and FAPs obtained from hospital Web sites, we examined characteristics of FAPs and associated expenditures for charity care in a representative sample of 170 tax-exempt hospitals. We identified common eligibility requirements and used them to define restrictiveness of FAPs. Results. FAPs were characterized by various ways to exclude patients, a patchwork of coverage for typical health care services, and wide-ranging discounts. FAP expenditures were lowest among restrictive hospitals in states that expanded Medicaid as part of the Affordable Care Act and highest among nonrestrictive hospitals in nonexpansion states. FAP expenses did not differ by hospital restrictiveness alone. Conclusions. Standardizing common eligibility requirements among FAPs carries potential benefits with regard to optimizing charity care for community benefit and achieving at least some level of equity; however, further policy efforts must account for additional restrictions, charges, and exclusions to be effective.


Author(s):  
Hossein Zare ◽  
Matthew Eisenberg ◽  
Gerard Anderson

Policymakers are using different ways to measure the community benefit provided by non-profit hospitals because different policy makers have different policy objectives. We compare 3 commonly used measures of community benefit; examine the correlation across the 3 measures; examine how the distribution of community benefits varies across non-profit hospitals; and compare the factors associated with the level of community benefit for each definition. The main dataset for this study is the Schedule H of IRS Form 990 data for 2017. We merged this data with the 2017 American Hospital Association (AHA), the 2017 CMS Hospital Cost Report, and the 2018 American Community Survey data. The final sample consists of 1904 non-profit hospitals. We define 3 measures of community benefit: (1) Total community benefits: combining all 17 possible measures in the 990 data; (2) Total community benefits less unreimbursed Medicaid care because it reflects a policy choice made by the state; and (3) only charity care. We also subdivided the community benefits into individual and service-based benefit. Gini Coefficients and descriptive analysis show the distribution of 3 types of community benefit measures. On average, hospitals spent 8.1% of their expenses on all community benefits; 4.3% on community benefits less unreimbursed Medicaid; and 1.7% on charity care. The provision of charity care showed more variation (Gini coefficient) than the other 2 measures. Different hospital and geographic characteristics were associated with each definition, suggesting that different types of hospitals place emphasis on different community benefits. When policy makers choose among different definitions of community benefit, they should consider what incentives they want to instill.


2018 ◽  
Vol 43 (2) ◽  
pp. 229-269 ◽  
Author(s):  
Simone R. Singh ◽  
Gary J. Young ◽  
Lacey Loomer ◽  
Kristin Madison

Abstract Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009–11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals.


2013 ◽  
Vol 3 (3) ◽  
pp. 7
Author(s):  
Simone Rauscher Singh

During the 2008 recession, many U.S. hospitals had to lay off staff and cut services to reduce costs, yet little is known about how these cuts affected hospitals’ provision of community benefits. While the need for charitable programs and services grew during this economically difficult time, financial pressures may have forced hospitals to cut back on their community benefit spending. Using data for not-for-profit hospitals in the state of Maryland for the years 2006 to 2010, this study explored whether, and if so how, hospitals changed their provision of community benefit during the 2008 recession. The findings showed that, on average, Maryland hospitals increased their charitable activities during the recent recession. Between 2006 and 2010, total spending on community benefits grew from an average of 5.6% to 7.7% of operating expenses with the most substantial growth in hospitals’ provision of charity care and mission-driven health services. Panel regression analysis showed that this increase in charitable activity was associated with increases in community need. Hospitals’ financial performance, on the other hand, was unrelated to their community benefit spending. These findings indicate that even in times of constrained budgets, Maryland hospitals provided substantial amounts of community benefit in response to the needs of the communities they serve. Hospital-based community benefit programs thus have the potential to play an important role in on-going community-wide efforts aimed at reducing the burden of illness and improving population health.  


Author(s):  
Aleksey E. Shishkin

Relevance. The market-imposed system of consumerism overstepped the boundaries of bifurcation and entered into “legitimate rights” to abolish the living traditional world, thereby disturbing the balance in society and thereby signed the death sentence to itself. The problem of research. Exploring the possibilities of social reloading from consumerism to communitarianism to restore the balance of power in society. Scientific novelty and research results. Our novelty of research lies in the application of scientific tools to analyze a possible reload. We used the complementarity principle of N. Bohr, the principle of spontaneous emergence of I. Prigogine, the principle of incompatibility L. Zade, the principle of managing uncertainties, the principle of ignorance of individual opinions and collective ideas, the principle of conformity, the principle of diversity of development of a complex system, the principle of unity and mutual transitions, the principle oscillatory (pulsating) evolution – showed instability in the management of society by mondialist-compradors and a possible countdown of the transition from the sensual age to the ideation nnuyu, and in our case – from consumerism to communitarianism. The main purpose of the work. From the apparent modern triumph of consumerism over communitarianism, we are not interested in a fact-problem, but in the idea of transforming reality that can stop the process of obscuration. Discussion and Conclusion. In the Middle Ages, during the construction of the project “Holy Russia”, communities were created according to the principle of “big”. Around the devotee of piety, voluntary monastic settlements were created, which grew into suburbs. Of these, the ascetic-hesychast stood out, who went into the forest and chopped down a new temple. To the righteous people flocked, yearning for a just life. This is how a new community was created. There was a new prayer book and then the big man blessed him to organize other settlements. The state should be interested in finding new forms of solutions for educational, economic, technical, cultural and food programs, therefore the initiative of communitarianists should not be punished, but supported. Today, foreign investors are becoming owners of not only factories, but even entire branches of domestic industry and are able to significantly influence domestic politics in our country. The growing number of immigrants as a destabilizing factor is becoming increasingly important. In such a situation, the fate of the country depends on the ability of the people to a new unification. It is necessary to unite on the basis of religious and cultural traditions on the principle of professional fraternities; if only there would be more centers of spiritual culture, but not by the principle of quantity, as is always the case with officials, but by the qualitative qualification of the “big man” as a center of creative and integrative power. From the foregoing, the idea of building ideational (communitarian) cohorts is born, which, through their ascetic life and creative work, should set a new vector for historical development (“salt”) consumer society.


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