美国非营利性医院联邦所得税免除制度：挑战、变迁及借鉴

非营利性医院在美国社会经济生活中发挥了重要的作用。在支持非营利性医院运营方面,税收优惠是政府对非营利性医院进行投入的一种间接方式。美国非营利性医院的免税制度在发展过程中曾受到多方的质疑,同时也促进美国税收制度在核定非营性医院免税标准方面的变迁。这些都对我国非营利性医院税收优惠制度的完善,具有良好的启示及借鉴意义。     

美国非营利医院社会责任报告制度及管理机制研究

通过非营利医院社会责任报告与免税或财政支持衔接的管理制度设计,政府机构与行业协会引导非营利医院承担社会责任,提升美国非营利医院履行社会责任的积极性.我国有必要建立利益相关者参与的公立医院社会责任报告制度,并设计适合国情的报告管理机制.     

医疗服务的品质考核

在可以自由选择的情况下．为什么要办非营利医院？为了回答这个问题．不少人容易在税收方面打主意。是的．各国政府通常给非营利医院以免税的优惠。营利医院抽税．非营利医院免税．形成了一个相对收益之差。逻辑上．只要这个差价足够大，总有人趋利避害．出头来办非营利医院吧？     

医疗服务的品质考核

在可以自由选择的情况下，为什么要办非营利医院？为了回答这个问题，不少人容易到税收方面去打主意。是的，各国政府通常给非营利医院以免税的优惠。营利医院抽税，非营利医院免税，形成了一个相对价格之差。逻辑上，只要这个差价足够大，总有人趋利避害，出头来办非营利医院吧？     

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。     

美国医院的结构特征与不同医院的绩效比较--兼谈对我国公立医院改革的思考

介绍了美国医院的结构特征,以及不同医院在1975-2001年的变化趋势,并根据文献对美国的非营利医院和营利医院的绩效进行了比较.借鉴美国分类医院的经验,提出了我国公立医院改革的一些思路,供卫生决策者参考.     

美国营利和非营利医院的评价

美国营利和非营利医院的经营目的的不同，但在管理方法和市场竞争策略上正在逐步趋同。它们相互竞争，在医疗服务的价格上各有高低，总体上是有竞争的医院医疗服务的价格要高于没有竞争的医院。在扣除了税收、公共的补贴及慈善损助等之后进行的分析发现，营利医院和非营利医院的医疗服务成本各有高低，但营利医院的医疗服务的效率相对较 。两种类型的医院医疗服务的质量总体上没有差别。非营利医院提供了较多的社会医疗服务。     

民办非营利医院监管中的制度设计漏洞——基于湖北、广东、江苏三省的调查

我国的民办非营利医院发展历程较短,在监管制度方面仍然存在诸多漏洞。本文在文献分析与湖北、广东、江苏三省现场调研的基础上,分析了目前我国民办非营利医院在准入流程、变更流程和"非营利性"监管三个方面的制度设计漏洞,并提出优化准入流程、增加补缴税款或清算的变更环节、建立"非营利性"的协同监管机制等政策建议,以期为我国民办非营利医院的健康发展提供决策参考。     

我国民办非营利医院发展的制度障碍与政策建议

本文总结了我国民办非营利医院发展的积极意义,从自主经营管理、平等竞争、投资收益、税费减免、治理与监督制度等方面分析了影响民办非营利医院发展的制度障碍,并提出了尽快修订完善医疗机构监管法规、建立和完善民办非营利医院资产财务管理制度、落实和完善自主经营管理制度、建立科学规范的治理监督机制等相关政策建议。     

纳税之惑 何以解忧

国家税收的两大职能是满足财政需要和宏观调控。就是一方面通过税收为国家提供稳定、充足的资金来源,是财政收入的主要支柱;一方面具有宏观调控职能,税收是财政调控手段的主要方式之一。我国在1994年税收之后,税收法律制度在统一、公平、科学方向上有所前进,税收调控更趋于规范,调控效应也有所改善。但是,目前我国政府税收形式和渠道不规范,调节缺位,税收     

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。     

Why nonprofits? Hospitals and the future of American health care

The future of the nonprofit hospital depends on its relationship to the for-profit and governmental sectors of our economy. A decade ago, the primary challenge came from the growing investor-owned hospital companies. Nonprofit hospitals' responses--both competitive and imitative--led to new challenges from government regarding tax-exempt status. The reasons underlying this challenge include the growing commercialism of health care, the nation's failure to deal directly with the problem of the uninsured, and the lack of a coherent theory of tax exemption. Although hospitals are likely to retain exemptions from federal taxation, challenges to local tax exemptions are likely to continue. Strategies that hospitals pursue for competitive purposes may undercut their legitimacy as tax-exempt institutions, but several groups are working to address the issue.     

Taxation of nonprofit hospitals: a cost impact model

At a time when taxing authorities at all levels of government are reexamining present exemptions, nonprofit charitable hospitals may become concerned about potential new tax liabilities. The Tax Impact Model described here can predict the dollar amount of new taxes, the probable amount of shortfall in major payers' reimbursement for these expenses, and the resulting net financial impact. This model incorporates a set of issues that should be considered and factors for which data or assumptions are needed. It can be applied to hospitals singly or in groups. Here, the model's application to a single hospital shows that payer mix and pretax financial strength are important determinants of the impact of taxation. These findings also suggest that hospitals with a large disproportion of Medicare and Medicaid patients, and those with small revenue margins, are least able to absorb new tax expenses.     

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.     

对医院征税的国际比较及其启示

通过对各国医院税收政策的比较分析，从理论与实践上探讨了对不同医院实行不同税收政策的依据，提出了国外有关医院税收政策对我国实行医院分类管理的政策建议。     

Health systems ownership: can regulation preserve community benefits?

This article addresses two questions. What determines the amount of community benefit a nonprofit firm will provide? What would be the expected effect of legal rules requiring nonprofit firms to provide more community benefit than they would otherwise have chosen? The amount of community benefit provided, it is argued, depends on the desires of the donors who endow the nonprofit firm with its equity capital and control its corporate board. The effect of a law requiring the provision of community benefit depends on the degree of competition in the local market. In competitive markets, such a rule is like a hidden tax. In markets in which nonprofit firms have market power, it may divert resources from types of benefit valued highly by the board toward activities valued highly by the political process. The definition of community benefit and the future of nonprofit hospitals are also discussed.     

Obstacles in the Development of Nonprofit Hospitals in Georgia

The most common form of ownership of medical establishments worldwide is a nonprofit organization. In contrast, the number of nonprofit medical institutions in Georgia is very scarce, while private profit organizations hold about 90% of the medical market. The goal of the research is to study the factors that affect the development of nonprofit hospitals in Georgia. Since there are very few nonprofit medial institutions in Georgia, we hypothesize that there is not enough motivation for functioning of such institutions. For the purposes of this research, six in-depth interviews were conducted with managers and experts of nonprofit organizations. As the research demonstrated, there is no sufficient motivation for functioning of the nonprofit form of medical organizations. Although the Tax Code provides tax benefits, they exist only in a token way and do not support the development of nonprofit medical organizations. It is necessary to improve the tax benefits provided for nonprofit hospitals in the Tax Code and share the world experience in order to increase number of nonprofit organizations in Georgia. It is recommended for Government to give more support to nonprofit organizations, in order to increase their functioning efficiency and bring incentive for development of new nonprofit medical institutions.     

Charitable care and the nonprofit paradigm

Nonprofit hospitals have begun to focus once again on serving the health needs of their communities. Governmental needs for additional revenue and for-profit hospitals' contention that tax exemptions give nonprofit hospitals an unfair competitive advantage have resulted in changes in laws and regulations and have caused a change in the role of nonprofit hospitals. As local governments become more responsive to the health needs of their communities, they are requiring nonprofit hospitals to become more responsive as well. Laws, regulations, and court decisions have begun to require nonprofit hospitals to provide charity care and services at levels equal to the amount of their exempt taxes. In response, nonprofit hospitals are developing community benefit programs and public health services.     

美国非营利性医院相关问题分析及对我国的启示

文章对美国非营利性医院的界定、特征、卫生经济学理论基础和税收政策进行了简要介绍,利用过去研究结果对非营利性和营利性医院运行情况进行分析,对今后我国的卫生研究和改革提出建议.     

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.