营利性医院的税费政策研究

通过对温州市公立医院和民营医院经济运营现状的抽样调查，从现行政策范围内，对当前制约民营医院发展的税费问题展开讨论，并对完善税费政策，鼓励民营医院的进一步发展提出了建议。     

Alternative method of funding hospital capital expenditures

This article presents a model that demonstrates how a hospital can form a strategic partnership with a vendor to use the vendor's previous knowledge, experience, and strategic alliances to fund capital expenditures and implement cost savings programs for the hospital, with no capital outlay or risk to the hospital. The vendor assumes full financial risk for the success of the program. In exchange for the vendor's full risk, the hospital shares in the savings with the vendor.     

Distinguishing community benefits: tax exemption versus organizational legitimacy

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural-cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.     

A review of state legislation and a state legislator survey related to not-for-profit hospital tax exemption and health care for the indigent

This study examines recent states' legislation related to the not-for-profit (NFP) hospital tax exemption and care to the uninsured and underinsured, and compares these legislative provisions to a past survey of state legislators' opinions about appropriate criteria for the NFP hospital tax exemption. To be tax-exempt, hospitals need to provide services that benefit the community. The problem lies in the ambiguous nature of the community benefits standard and the type of information required for compliance with the standard. As a consequence, NFP hospital tax-exemption challenges have occurred across the nation, resulting most recently in a federal class action lawsuit against NFP hospitals across several states. Empirical research has examined whether the NFP hospital tax exemption is justified based on the amount of community benefits and charitable care provided, without examining the type of policy alternatives that might be proposed by legislators who are responsible to change and create tax-exemption regulations. This article surveys state legislators and examines state legislation. The survey reveals that legislators from states with tax-exempt challenge activity focus more narrowly on the provision of charitable care and that state legislators consider quantitative information to be as important as qualitative information for the tax-exemption decision. Essentially, the survey predicts that state legislation would focus primarily on charitable care policy and indigent care guidelines, which is confirmed by the review of recent state legislation; however, there is still much variation in tax-exemption legislation between states. More standardization is needed to address the needs of indigent patients equitably.     

Collaboration to improve services for the uninsured: exploring the concept of health navigators as interorganizational integrators

This study examines one specific type of collaboration activity in a community health collaborative. The focus of the research is the operations level where services are coordinated, patients are referred, and access may be improved for vulnerable populations. Using a case study approach, we examine the creation of a new interorganizational role, the "health navigator" in the Miami-Dade Community Access Program. Drawing on traditional theoretical perspectives on coordination, we present the health navigator as an "integrator" among a complex set of safety net providers and public health insurance programs.     

Support for HPV vaccine school-entry requirements in the United States: The role of exemption policies

In the United States (U.S.), only five states or territories require human papillomavirus (HPV) vaccination for school attendance, even though almost all U.S. jurisdictions have debated adopting this type of policy. In this U.S. based study, we sought to estimate the level of support for HPV vaccine school-entry requirements with varying exemption policies and documentation procedures to obtain exemptions. Between July and August 2019, we conducted a web-based survey with a national sample of 1,109 U.S. parents of 11- to 17-year-olds. The survey assessed support for four school-entry vaccine requirement policies: without exemption or with exemption for medical, religious or philosophical reasons. Analyses used multivariable logistic regression to assess correlates of support for each policy. Overall, 38% of parents agreed with laws requiring HPV vaccination for school attendance without exemptions. When including exemption provisions, agreement increased to 45% for philosophical reasons, 50% for religious reasons, and 59% for medical reasons. Parents more often agreed on requirements without any exemptions if they were female (OR = 1.37, 95% CI:1.01–1.87), their child had initiated HPV vaccination (OR = 2.05, 95% CI:1.50–2.87), reported high levels of vaccine confidence (OR = 2.41, 95% CI:1.77–3.27), or reported having values similar to those of the people in their community (OR = 1.85, 95% CI:1.39–2.47). Parents more often agreed with requirements that included religious or philosophical exemptions if they reported having values similar to their community or high levels of psychological reactance (all p <.05). Many parents also supported requiring a written notice signed by a health care provider (40%) or religious leader (49%) to obtain a medical or religious exemption, respectively. In conclusion, exemption policies greatly increase parent support of school-entry requirements for HPV vaccination but may decrease their impact in practice. A large number of U.S. parents support strict documentation to obtain exemptions, signaling a promising area of policymaking to strengthen vaccine policies for school attendance.     

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.     

Champaign County, Illinois, gets hospital industry's attention by revoking property tax exemption of local catholic hospital [interviewed by Stan Jenkins

A property tax exemption is not necessarily permanent: Certain responsibilities are conferred along with tax-exempt status. If those responsibilities are not met, the tax exemption may be revoked. An interview with Stan Jenkins, Chairman of the Champaign County Board of Review, explains the rationale behind revocation of the property tax exempt status of a local charitable hospital, which may have far-reaching implications for others in the healthcare industry.     

Patient-friendly hospital environments: exploring the patients' perspective

Objective To investigate the perceptions and attitudes of patients to the built environments of NHS Trust hospitals, in order to inform design excellence so as to make future hospitals places and spaces responsive to patient needs. Design An exploratory study of patients perceptions based on qualitative semi‐structured personal interviews. Setting and participants Fifty one‐to‐one interviews held with hospital in‐patients across the four directorates of surgery, medicine, care of the elderly and maternity at Salford Royal Hospitals NHS Trust, Salford, UK. Results The research found that there was much similarity in the priorities, issues and concerns raised by patients in each of the four directorates. Patients perceived the built environment of the hospital as a supportive environment. Their accounts in each area pointed to the significance of the factors that immediately impacted on them and their families. Patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggest that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. Conclusions The findings have important implications for capital development teams, clinical staff, managers and NHS Estates personnel. Although the study has immediate relevance for Salford Royal Hospitals Trust, findings and recommendations reported provide NHS Estates and other relevant stakeholders with evidence‐based knowledge and understanding of patients’ perceptions and expectations of and preferences for particular facilities and estates provision in NHS hospitals.     

User fee exemption policies in Mali: sustainability jeopardized by the malfunctioning of the health system

In Mali, where rates of attendance at healthcare facilities remain far below what is needed, three user fee exemption policies were instituted to promote access to care. These related to HIV/AIDS treatment, as of 2004, caesarean sections, since 2005, and treatment of malaria in children under five and pregnant women, since 2007. Our qualitative study compared these three policies, looking at their implementation provisions, functioning and outcomes. In each healthcare facility, we analysed documentation and carried out three months of on-site observations. We also conducted a total of 254 formal and informal interviews with health personnel and patients.While these exemptions substantially improved users' access to care, their implementation revealed deep dysfunctions in the health system that undermined them all, regardless of the policy studied. These policies provoked resistance among health professionals that manifested in their practices and revealed, in particular, the profit-generation logic within which they operate today. These dysfunctions reflect the State's incapacity to exercise its regulatory role and to establish policies that are aligned with the way the health system really works.     

Legal, policy, and practical perspectives on hospital discounting and collection policies for uninsured and underinsured patients: a primer for board members and managers

This article addresses many of the issues hospital boards and management must consider with regard to discounting and collection policies for uninsured and underinsured patients. Viewing these issues from the perspective of the overall charitable mission of the hospital will allow a hospital to respond more to community need than fear of lawsuits or adverse publicity. The legal and reimbursement consequences of any course of action must, however, be assessed by hospitals and their advisors.