Nonprofit ownership, private property, and public accountability

Mark Schlesinger and Brad Gray have summarized research comparing nonprofit and for-profit health care in a remarkably useful form. Their paper effectively demonstrates how nonprofit and for-profit health care differ. However, their proposal for community control over nonprofit health care organizations in exchange for tax exemption, like many current proposals requiring nonprofit hospitals to provide free care for indigent patients, risks undermining the purpose of the nonprofit organizations and the care they provide. These trade-offs are significant yet have not been acknowledged in policy debate.     

美国非营利性医院税收法律制度研究

非营利医院在美国社会中占有重要的地位.在支持非营利医院运营方面,美国主要通过税收优惠对非营利医院进行间接支持.除税收优惠外,美国还制定了惩罚性税收和严格的税收管理制度来规范非营利医院的活动.美国非营利医院的税收法律制度为我国非营利医院税收制度提供了借鉴.我国应吸收其合理成分,以完善我国非营利医院税收法律制度.     

美国营利性和非营利性医院的比较研究及对我国卫生改革的启示（之二）

在微观水平上分析了美国营利性医院和非营利性医院的规模,服务能力和经营状况等,在此基础之上,结合我国医疗机构分类管理的发展趋势,对我国营利性医院和非营利性医院的发展策略提出了若干建议。     

广州公立医院改革的问题与对策分析

广州公立医院改革中存在的主要问题是：政府投入比重逐年下降，公立医院公益性淡化：政策导向使公立医院渐趋逐利性：医疗保障体系不健全．基本医疗保险覆盖率低，直接影响公立医院的生存与发展。针对上述存在问题．建议采取以下对策：控制大型医院发展规模，规范服务范围，打造精品公立医院：发展社区卫生服务，扶持基层医院，形成双向转诊机制：建立全民基本医疗保障体系，为深化公立医院的改革创造有利条件。     

公立医院财政拨款不足情况下财务关系的处理

公立医院是为了社会公益目的,由国家出资举办,并受国家行政部门监督和管理,从事医疗卫生活动,承担公共卫生职能,追求社会效益的非营利性组织,其经费来源,一是财政拨款,二是开展医疗服务的收入。本文结合单位实际情况,论述现阶段工作中财政拨款不足的困惑,探讨财务关系的处理,以利于医疗卫生机构稳定发展。     

The consumer welfare implications of the hospital ownership mix in the US: an exploratory study

This paper offers an empirical test concerning how hospital ownership mix affects consumer welfare in the US. The test compares the market benefits and costs resulting from an increased presence of nonprofit hospitals by observing empirically how the nonprofit market share impacts hospital care utilization at the margin. The empirical results suggest that too many not-for-profit and public hospitals exist in the inpatient care segment of the typical hospital services industry of the US. In contrast, the empirical findings indicate that too many for-profit hospitals operate in the outpatient care portion of the hospital services industry. The policy implication is that more quality of care per dollar might be obtained by promoting increased for-profit activity to inpatient care and more nonprofit activity to outpatient care in some market areas. This conclusion, however, is tempered with several caveats. We discuss these and also make recommendations for further research.     

浅析医疗机构之税法规制

随着改革开放的深入,我国医疗机构的投资主体呈现出多元化趋势,国家确立了新的医疗机构分类管理制度,将医疗机构分为非营利性和营利性两类进行管理。《关于医疗卫生机构有关税收政策的通知》也对两类医疗机构的税收课征予以具体规定。文章从我国医疗机构课税制度的现状分析出发,结合医疗机构的特殊属性,对完善医疗机构之税法规制提出若干建议。     

The physician as a source of hospital capital

As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)     

共赢：医院又好又快发展的思路及对策

基于竞争合作理论,分析我国二级以上医疗机构目前运营现状在社会效益和经济效益两方面均存在巨大差别,指出实现多方共赢、医院又好又快发展的思路和对策一是医院外部管理体制及其运行机制的变化或改革;二是发挥非政府组织在卫生服务上的监管作用;三是以服务对象为中心的医院经营理念;四是医患关系的和谐;五是医院履行社会责任;六是医院内部管理体制和策略的变革--医院内部核心竞争力的构建。作者认为,医院内部管理体制和策略的变革,在我国现行医疗卫生体制、医疗环境和国家的经济发展水平等诸多环境背景下是更为重要而紧迫的问题和值得深入研究的课题,而医院核心竞争力的构建将可能是实现医院、服务对象、社会三方共赢的纽带。     

我国公立医院法人治理的路径选择及政策建议

公立医院法人治理结构的建立和完善是我国医药卫生体制改革的重要内容之一。为破解公立医院法人治理的难题,应借鉴利益相关者理论和多中心治理理论,构建利益相关者参与治理,以及建立政府、市场和社会三维框架的治理模式。基于这样的路径选择,我国应建立和完善相关配套政策：第一,建立公立医院出资人制度,彻底实现＂管办分离＂。第二,公立医院与民办非营利医院相比,享受更为优惠的税收制度,这使得税法对于非营利医院治理机制的规制作用无法发挥。因此,应建立公平的税收法制环境,发挥税法对公立医院法人治理的规制作用。第三,公立医院法人治理需要公众的参与,而信息公开是公众参与治理的制度保障。     

Evaluating Hospitals’ Provision of Community Benefit: An Argument for an Outcome-Based Approach to Nonprofit Hospital Tax Exemption

Nonprofit hospitals are exempt from federal income taxation if they pass organizational and operational tests, including satisfying the community-benefit standard. Policymakers, however, have questioned the adequacy of the community benefits that nonprofit hospitals provide in exchange for these exemptions.The Internal Revenue Service recently responded to these concerns by redesigning its tax forms for nonprofit hospitals. The new Form 990 Schedule H requires nonprofit hospitals to provide additional information about their community-benefit activities. This new reporting requirement, however, places an undue focus on input-based community-benefit indicators, in particular expenditures.We argue that expanding the current input-based reporting requirement to include not only monetary inputs but also population health outcomes would achieve greater benefit for society.NONPROFIT HOSPITALS ARE vital to the health and welfare of millions of Americans1 and constitute a major portion of our economy.2 The tax exemption that these institutions received was worth $12.6 billion in 2002 and has subsequently grown.3 To remain tax-exempt, nonprofit hospitals have to meet the Internal Revenue Service’s (IRS’s) community-benefit standard, which grants health care organizations tax exemptions in exchange for engaging in activities that promote health for the benefit of the community.4Policymakers have recently started to question the adequacy of the community-benefit activities that nonprofit hospitals provide in exchange for their substantial tax exemptions. The IRS responded to these concerns by redesigning its federal tax return for nonprofit hospitals, Form 990, and adding Schedule H.5 However, this new reporting requirement only partially achieves its policy objective because it is hampered by an undue focus on input-based indicators of community benefit, in particular how much nonprofit hospitals spend on community-benefit activities. The current standard does not assess the health outcomes that these community-benefit activities do or do not help to achieve. The community-benefit standard would provide a more meaningful evaluation of hospitals’ community-benefit activities if it complemented input-based measures of community benefit with information on population health outcomes, thereby better effectuating the standard’s original policy goals and achieving greater benefit for society.6A standard that includes input as well as outcome measures would offer significant incentives for nonprofit hospitals to increase public benefit. A new community-benefit standard should thus take a more balanced approach, evaluating both input and outcome-related measures, which show how benefit accrues to the public. A more robust conception of community benefit, with tighter criteria for inclusion and exclusion of potential population benefits, would help facilitate this transition.Provisions in the Patient Protection and Affordable Care Act (ACA) have modified the community-benefit standard to include measures of both input and outcomes. As of this year, nonprofit hospitals are required to conduct regular community-health needs assessments and implement improvement plans, which may provide some of the information necessary for a meaningful evaluation of the outcomes of a hospital’s community-benefit initiatives.7Policymakers at both the federal and state level have many tools at their disposal to help make the community-benefit standard more outcome-focused. The IRS, for instance, could require nonprofit hospitals to complement their community-benefit expenditures disclosed in Form 990 Schedule H with a detailed report on the population health outcomes of their community-benefit activities. Federal and state governments could then use this information when deciding whether to grant nonprofit hospitals tax exemptions.     

Hospital community benefits other than charity care: implications for tax exemption and public policy

Recent policy initiatives attempt to link the tax treatment of nonprofit hospitals more closely with the provision of social benefits. A key issue in defining these benefits is the treatment of "community benefit" programs and services. While their costs are often unreimbursed, these programs differ from traditional charity care in terms of the populations whom they benefit and the motivation for their provision. Community benefit programs are typically targeted to the general population, rather than the poor or other underserved groups, and often serve a marketing function.     

公立医院与民营医院适用的税收政策比较

目的:揭示公立医院和民营医院适用税收政策面临的问题,为引导公立医院和民营医院健康发展提供政策支持。方法:采用对比分析和描述分析方法,对公立医院和民营医院应税收入与适用的税收政策进行比较。结果:公立医院与民营医院税收政策面临企业所得税和营改增试点衔接制度不完备的问题,难以指导实务;以医院性质作为纳税或免税认定条件违背税收公平原则;过高税负影响民营医院竞争力和发展后劲;医院财务不透明,监管缺位,税收优惠政策难以落实。结论:明确医院增值税应税项目及其会计核算体系;按医院医疗服务项目性质,确定是否缴纳增值税和企业所得税;建立医院财务信息公开制度,增强收支和税费透明度。     

Tax preferences for nonprofits: from per se exemption to pay-for-performance

Defenders of tax preferences for nonprofit hospitals and health plans, including Mark Schlesinger and Brad Gray, contend that nonprofits deserve government support because they provide greater "community benefit" than their for-profit counterparts. This argument is unconvincing. There is some evidence that nonprofits deliver marginally more "community benefit" but no evidence that tax exemption is the cause. Absent proof that tax expenditures, including exemption, "buy" social benefits that are worth the cost to taxpayers, these expenditures are unjustified. The better course would be to pay nonprofits for performance, by tying tax benefits to accomplishments (beyond current achievements) in health promotion, quality, and care for the needy.     

社会资本与民营非营利性医疗机构的发展空间

社会资本指的是社会组织的特征,如信任、规范和网络,它是无形的,可以通过促进合作行动提高社会效率。随着我国医疗改革的深入,由民间资本创立,旨在提供社会公共卫生服务的非营利性医疗机构将作为国有非营利性与民营营利性医疗机构的有效补充在医疗市场发挥作用。树立民营非营利性医疗机构的良好社会公众形象并获得群众大力支持和帮助,赢得慈善机构捐资、争取企业或个人赞助等均是非营利性医疗机构创造并利用社会资本,赢得生存和发展空间的关键。     

社会资本举办非营利性医疗机构制约因素研究

社会资本举办非营利性医疗机构,特别是综合性医院,在我国的设立和发展仍因受到诸多因素的制约而步履维艰.通过对法律政策、卫生监管、服务价格和医疗保险因素的实例分析和理论探讨,为进一步研究社会资本举办非营利性医疗机构的政策建议提供依据.     

论医院软实力建设

随着社会主义市场经济体制的不断完善和医疗卫生体制改革的不断深入,医疗卫生机构需要为构建和谐社会提供优质的医疗服务,传统的"设备+技术"的竞争模式,已经被评价医院整体软实力的新模式所替代。坚持以科学发展观为指导,加强医院软实力建设,是医院增强自身核心竞争力,实现可持续发展的必然要求。医院软实力结构模型以核心价值观为支柱,文化吸引力为动力,团队精神为标志。方法上坚持以先进的文化理念为引领,人性化的管理为手段,人性化的服务为保障,发挥医院的专科技术和人才优势,积极培育和塑造医院品牌魅力,最终实现医院科学发展。     

公立医院企业所得税税收筹划探析

文章对三甲公立医院在申报企业所得税过程中面临的经营支出与医疗支出无法准确划分的问题,通过研究近年来税收政策及收费依据,得到以下结论:应优先为医院申请政策上的优惠,力争减免税款,此外考虑分摊比例法或核定征收企业所得税的方法,实现企业所得税经营支出的精准核算,并对医院企业所得税进行筹划,在不违反税收政策前提下实现医院税收利益最大化。     

特色专科医院发展专病健康管理的实践与思考

目的:探索适合专科医院发展健康管理的模式,推动专科医院的健康管理学科发展。方法:通过文献研究,了解其他专科医院在健康管理方面的经验,结合本院健康管理工作实践,加以分析思考。结果:梳理了专科医院发展健康管理的优势,在本院初步实践基础上思考专科医院如何发展健康管理。结论:健康管理作为一门新兴的学科,具有广阔的发展前景,大中型公立医院开展健康管理建设,不仅是医院适应社会发展及医学模式转变的明智选择,更是促进全民健康、提高全民健康水平的有效手段。专科医院作为医疗机构的重要组成部分,其在专病健康管理方面具有得天独厚的优势。     

国内医院转化医学发展动态分析

从机构建设和科学研究两个角度分析国内医院转化医学发展现状.机构建设方面,美国转化医学中心的依托单位多为大学,组织架构较完善;国内的依托单位多为医院或临床中心,较为分散,多为自发成立,缺乏国家层面的规划部署,难以形成比较高效的转化医学研究体系.但机构建设的迅速发展带来了转化研究成果的增多.国内转化医学研究多为从基础医学的角度探索疾病的致病机制和干预措施,如将实验室技术、细胞生物学、生物化学与分子生物学、药理学、应用生物技术等和临床问题的整合,特别是肿瘤、心血管病、内分泌与代谢病、消化系与腹部疾病等临床领域的转化研究受到了国内较多的关注.最后提出国内医院转化医学发展的策略和建议.