Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

6
Does Mission Really Matter? Measuring and Examining Charity Care and Community Benefit in Nonprofit Hospitals

Susan M. Sanders

Since the adoption of the federal corporate income tax in 1909, the majority of hospitals have generally been accorded tax-exempt status as part of their nonprofit incorporation (see Section 501(c)(3) of the Internal Revenue Code [IRC]). However, nonprofit hospitals have been exempt not only from the federal corporate income tax, but also from state sales taxes, from local property taxes and federal unemployment taxes, and from the communications excise tax. In addition, nonprofit hospitals are eligible to receive discounts on postal rates and may apply for tax-exempt revenue bonds to finance capital projects. Moreover, individual contributions made to nonprofit hospitals are tax deductible for the donor under Section 170(c)(2) of the IRC.

At the legal and policy levels, these circumstances suggest questions about the justification for treating nonprofit hospitals differently from their for- profit counterparts. At philosophical and organizational levels, the treatment and behavior of nonprofit hospitals relative to their for-profit counterparts raise questions about the mission of nonprofit hospitals.


LEGAL AND POLICY QUESTIONS

From legal and policy perspectives, nonprofit hospitals have been criticized for the unfair competitive advantage they have over their for-profit competitors. For example, local businesspeople have argued that they have a competitive disadvantage because nonprofit hospitals operate tax-exempt businesses such as gift shops, restaurants, laundries, food services, and med-

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