Hospital community benefits and the effect of Schedule H: A difference-in-difference approach

Abstract

Since 1969 private, nonprofit hospitals have qualified for tax exemption as charitable institutions and in exchange for the preferential tax treatment were required to provide community benefits. However, in the absence of mandatory reporting of community benefits at the federal level and in the absence of a clear definition of community benefits, the previous literature provides but ambiguous evidence regarding hospitals’ supply of community benefits. Responding to policymakers’ concerns, the Internal Revenue Service (IRS) mandates all private, non-profit hospitals to report charity care at cost as well as unreimbursed Medicaid costs starting with the tax year 2008. Using data from hospitals in California before and after tax year 2008 (2009 filing), this study examines whether changes in the IRS 990 Schedule H had a significant effect on the supply of community benefits by non-profit hospitals relative to for-profit hospitals. Empirical results suggest that nonprofit hospitals do not supply more community benefits relative to for-profit hospitals for both definitions of community benefits reported in Schedule H. Although the supply of community benefits increased for all hospitals after 2008, the increase was not higher for nonprofits. Moreover, nonprofits supplied significantly less community benefits according to some definitions. Thus, minimum charity care standard is justified.

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Schneider, H. and Yilmaz, H. (2013) Hospital community benefits and the effect of Schedule H: A difference-in-difference approach. Health, 5, 1681-1688. doi: 10.4236/health.2013.510226.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Kane, N.M. (2006) Statement to the United States Senate Committee on finance, taking the pulse of charitable care and community benefit at nonprofit hospitals, Washington DC, 13 September.
http://finance.senate.gov/imo/media/doc/091306nktest.pdf
[2] US Government Accountability Office (GAO) (2008) Variation in standards and guidance limits comparison of how hospitals meet community benefit requirement.
http://www.gao.gov/assets/290/280709.pdf
[3] Salinsky, E. (2009) Schedule H: New community benefit reporting requirements for hospitals. Issue Brief National Health Policy Forum, 21, 1-25.
[4] Gray, B. and Schlesinger, M. (2009) Charitable expectations of nonprofit hospitals: Lessons from Maryland. Web Exclusive, Health Affairs, w809-w821.
[5] Hellinger, F.J. (2009) Tax-exempt hospitals and community benefits: A review of state reporting requirements. Journal of Health Politics, Policy and Law, 34, 37-61.
http://dx.doi.org/10.1215/03616878-2008-991
[6] Sutton, J.P. and Stensland, J. (2004) Promoting accountability: Hospital charity care in California, Washington State, and Texas. Journal of Health Care for the Poor and Underserved, 15, 237-250.
http://dx.doi.org/10.1353/hpu.2004.0030
[7] US Congressional Budget Office (CBO) (2006) Nonprofit hospitals and the provision of community benefits. CBO, Washington DC.
[8] Morrisey, M.A., Wedig, G.J. and Hassan, M. (1996) Do nonprofit hospitals pay their way? Health Affairs, 15, 132-144. http://dx.doi.org/10.1377/hlthaff.15.4.132
[9] Norton, E.C. and Staiger, D.O. (1994) How hospital ownership affects access to care for the uninsured. RAND Journal of Economics, 25, 171-185.
http://dx.doi.org/10.2307/2555860
[10] Schneider, H. (2007) Paying their way? Do nonprofit hospitals justify their favorable tax treatment? Inquiry, 44, 187-199. http://dx.doi.org/10.5034/inquiryjrnl_44.2.187
[11] Bazzoli, G.J., Clement, J.P. and Hsieh, H. (2010) Community benefit activities of private, nonprofit hospitals. Journal of Health Politics, Policy and Law, 36, 999-1026.
http://dx.doi.org/10.1215/03616878-2010-036
[12] Senate Finance Committee (2007) Tax-exempt hospitals: Discussion draft.
http://grassley.senate.gov/public/releases/2007/07182007.pdf
[13] Hsieh, H. and Bazzoli, G.J. (2012) Medicaid disproportionate share hospital payment: How does it impact hospitals’ provision of uncompensated care? Inquiry, 49, 254-267. http://dx.doi.org/10.5034/inquiryjrnl_49.03.02

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