业界新闻
中国富贵病日趋严重,医疗系统面临严峻挑战
十二五期间力争医药卫生重点领域改革有突破
陈竺:今年将抓好取消以药补医相关政策落实
卫生部部长陈竺:积极开展卫生人才继续教育
陈竺、王振义荣获“影响世界华人大奖”提名
卫生部:切实落实安保措施增强应急处置能力
人民日报两会之后话民生:今年医改主攻什么
卫生部部长陈竺要求:严打残害医务人员罪行
哈医大一院为被患者砍死医务人员举办追悼会
卫生部通知要求:切实维护医疗机构治安秩序
卫生部要求医疗机构要做好内部治安保卫工作
加快全民医保体系的健全,建立和谐医患关系
卫生部要求严格执行事先告知和知情同意制度
陈竺:中国传染病和慢性病双重疾病负担加重
哈尔滨医科大学附属第一医院发生恶性伤医案
中国青年报:医改规划结束“给政策不给钱”
半月谈:解读“十二·五”医改规划实施方案
医改在基层:看病“一口价”推广难点在哪?
医院杀医血案:未成年患者砍死硕士实习医生
哈尔滨二十八岁实习医生命丧十七岁患者刀下
科学学位研究生能否报考医师资格无确切说法
哈尔滨患者持水果刀捅医生致一死三伤被抓获
哈尔滨医院发生伤害医务人员案件致一死三伤
药监局提醒关注香丹注射液严重不良反应问题
《人民日报》政策聚焦公立医院收入不靠药品
中国青年报:饶毅施一公为何落选中科院院士
国务院要求扭转公立医院逐利,禁止举债建设
医改办负责人:五大措施保障十二五医改规划
新华每日电讯:为何医生宁可走穴不多点执业
卫生部部长陈竺访谈:东方智慧驯化恶性肿瘤
政协委员热议医保制度莫让患者“望医止步”
李克强:今年研发费用支出预计或达一万亿元
黄洁夫:解决医患矛盾需要在制度上找突破口
自然:中国的科学研究资助评估体系需要改革
美国癌症协会发布新的宫颈癌预防和筛查指南
陈竺:八百六十万医务工作者绝大部分是好的
卫生部部长陈竺:公立医院不能搞过度市场化
基层医院招聘难:大学生称待遇低发展空间小
人大代表呼吁出台政策支持取消“以药补医”
人大代表称医生拿红包收回扣是极个别的现象
瞭望新闻周刊:深化医改需要从三个方面突破
钟南山高调问政:作为医生就应该讲真话实话
医疗改革成效显著,加速推进需在体制上突破
医改投入虽快于经济增速看病难亟需深入破题
科学:关注中国政府工作报告的科研投入部分
肺癌等十二类大病将纳入保障和救助试点范围
卫生部:现行医疗服务体制缺陷升级医患矛盾
医疗服务没有实现公益性,医改就是做好药改
中国医改进深水区,代表委员支招破解看病难
攻坚公立医院改革,黄洁夫开出社会资本药方
抗菌药物临床不合理应用问题医师将受到处罚
国家中医药管理局局长称活熊取胆属无奈之举
新版基本药物目录扩容近一倍,医药分离试水
中国医改三年投逾一万亿,鼓励民间资本办医
陈竺:加强末期病患人文关怀以改善医患关系
陈竺:医院将撬动价格机制改革不按项目收费
特写:卫生部部长陈竺参加政协大会举步维艰
德国将定期询问成年人是否同意死后捐赠器官
荷兰推出安乐死新服务可以上门协助病人自杀
《人民日报》学术期刊出版大国的尴尬与梦想
全国首批居民健康卡今日在四个试点省区发放

临床时讯 > 业界新闻


美国:非营利性医院的“非营利性”遭受质疑
2010-08-16


  在美国,大到公共卫生,小到青光眼筛查,非营利性医院都提供了社会福利,因此可享有税务豁免的权利。但近日有媒体指出,这些医院给社会提供福利的资金尚不足以抵扣税款,非营利性医院的非营利性遭到了公众质疑。

  据2008年资料显示,佛罗里达州某营利性医院该年花费4420万美元,即总收入的7%用在糖尿病预防等社会福利的服务上,而当地非营利性医院仅花费213万美元,即总收入的4%用于社会福利。

  专家表示,尽管两种医院存在区别,即营利性医院将其收入返还给股东,非营利性医院将其利润用于卫生项目、社会福利服务以及资助医学科学发展上。但是,非营利性医院目前颠覆非营利本质的做法正在缩小两者的差异。

Are nonprofit hospitals truly not for profit?

Tax breaks rankle some critics, who ask: "What are you giving the community?"

When Florida Hospital and United Healthcare started their public wrangling over a new contract this summer, each side pointed to the other company's profits.

Both companies are health-care behemoths. Minnesota-based United Healthcare is the largest health insurer in the United States, with profits of $3.8 billion in 2009. Adventist Health System, which operates Florida Hospital system, is the largest nonprofit Protestant health-care provider in the nation, operating 37 hospitals in 12 states and generating $363 million in profit in 2009.

But in the high-dollar world of health care, what does it mean to be a nonprofit hospital that makes big profits?

"If you go back 100 years, these were charity hospitals. They took care of the poor," said Frank Sloan, a professor of health-care economics at Duke University. "But as health care has grown, they've become commercial. Now these nonprofits are in a big business."

Today's nonprofit hospitals - which make up slightly more than half of the nation's 5,000 community hospitals - are trying to juggle the demands of making money with being a charitable organization.

"You're supposed to show a good bottom line, but at the same time you're supposed to show that you lost tons of money by giving charity care," said Jessica Berg, a law professor at Case Western University who has studied the nonprofit-hospital system and its tax structure. "We're used to thinking of churches and religious organizations as nonprofits - whoever thinks of a for-profit church?"

For legislators across the country, there's growing tension that massive nonprofit-hospital organizations don't pay any taxes.

"The question is: What is the nonprofit doing that for-profits are not? We're giving them a huge tax benefit," Berg said. "So what's the trade-off? You're not paying taxes, so what are you giving the community?"

Charity care

For nonprofit hospitals, much of the community benefit is measured in two ways: through charity care and "community-benefit programs," which can range from health fairs to glaucoma screening. At Florida Hospital, those programs also include a diabetes-prevention program among Hispanics in east Orange County and a congestive- heart-failure clinic for those with Medicaid or no insurance.

Charity care - the free care that hospitals provide to those with no insurance or the amount of a bill they write off because the patient is unable to pay - has come under more fire from legislators across the country as questions arise about how much the hospitals are writing off.

In 2008, in documents provided to the state of Florida, Florida Hospital reported spending $442 million - or 7 percent of its patient revenues - on charity care. Its competitor, nonprofit Orlando Health, spent $213 million - or 4 percent of its patient revenues - on charity care.

Florida Hospital accepts more Medicaid patients than any hospital system in the state except Jackson Memorial in Miami, said Richard Morrison, Florida Hospital's regional vice president for governmental relations.

Yet the amount of charity care the hospitals are providing is unclear, said Becky Cherney of the Florida Health Care Coalition. If the hospital performs an appendectomy on an uninsured person, she said, hospital officials may write off the "full price" of the care at $11,000, but insurance companies, which negotiate rates, pay about half that. So what's the real cost to the hospital?

"When they do their charity care, they take the whole $11,000," Cherney said.

And everybody in the business, said Berg, "knows that that's a make-believe number."

Hospitals on a spree

Though for-profit hospitals send their profits back to shareholders, nonprofit hospitals can pump those profits into community-health programs, charity care and financing new technology and buildings.

The hospital system has invested in liver- and heart-transplant programs, which are not moneymakers, Morrison said. And, to support the new University of Central Florida medical school, Florida Hospital has expanded the number of medical residents it accepts - at its cost.

"You put money into services that the community needs, but that are not necessarily something you would invest in ordinarily," Morrison said.

In the past decade, Central Florida's two competing nonprofit-hospital systems have been on a building spree, trying to gain market dominance.

Florida Hospital has increased the size of several of its existing hospitals - for example, the recent 300-bed expansion at Florida Hospital Orlando - and expanded its reach into other counties with its network of 18 hospitals. In June, Florida Hospital executives signed a five-year operating agreement with Bert Fish Medical Center in New Smyrna Beach with an option to buy the hospital. In the Tampa area, Florida Hospital is negotiating to buy three hospitals and a long-term-care center.

Orlando Health operates six hospitals and partially owns two more, one in Osceola County and another in Lake County.

"These are turf wars," Cherney said. "We have two competing systems, so they both want to be sure they're in the right place. And Florida Hospital is very aggressive about the turf war."

The problem, she said, is that nonprofits such as Florida Hospital and Orlando Health also are buying doctors' practices and lab services, squeezing out competition.

"They're not just buying hospitals," Cherney said. "They're buying doctors' practices that operate in these hospitals - and then that's a true monopoly."

Hospitals in such an arms race "probably overbuild, over-technologize, and quality often will go down," said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance.

Once they invest in expensive technology like robotic surgery systems or MRIs, hospitals have to use the machines frequently or raise rates.

"Unless you use it all the time, you're going to have to charge more for it," Anderson said.

Customer satisfaction

In recent years as local nonprofit hospitals have expanded, their new wings look less like old-fashioned hospitals and more like high-end hotels. That may rankle critics, but experts say that hospitals - even nonprofits - are competing for customers.

"From an economic point of view, they're doing exactly what they should be doing," said Anderson at Johns Hopkins. "The flat-screen TVs and fancy buildings attract patients. And since the patient doesn't really have to pay more for the flat-screen TVs" - because the rates have been negotiated - "they are going to go to them."

And, because Medicare scores hospitals - in part - on patient satisfaction, a hospital with the latest amenities may come out ahead.

"Nobody wants to be sick and stuck in a tiny little room - and people don't like sharing rooms, either," said Florida Hospital's Morrison. "So the standards for room size have changed over the years."

That conflicts, however, with the old-fashioned notion of nonprofits, Berg said.

"We're a very torn society when we think about health care," she said. "We don't like to accept that it's a business, but we fundamentally insist that it's a business model."

治疗指南
临床诊疗指南肠外肠内营养学分册
中国儿科肠内肠外营养支持临床应用指南
中国新生儿营养支持临床应用指南
神经系统疾病营养支持适应证共识、神经系统疾病肠内营养支持操作规范共识
恶性肿瘤患者的营养治疗专家共识
肠屏障功能障碍临床诊治建议
外科患者胶体治疗临床应用专家指导意见
美国国家癌症综合网络(NCCN)临床实践指南(国际版)
美国国家癌症综合网络(NCCN)临床实践指南(中国版)
美国肠外肠内营养学会(ASPEN)临床指南
欧洲肠外肠内营养学会(ESPEN)指南
欧洲肠外肠内营养学会肠内营养指南
美国东部创伤外科学会创伤患者营养支持实践治疗指南
美国感染病学会(IDSA)实践指南
美国长期护理机构居住者发热及感染评估指南
中国抗菌药物临床应用指导原则
儿童社区获得性肺炎管理指南(试行)概要
美国国家癌症综合网络(NCCN)《非小细胞肺癌临床实践指南》
2011年美国国家癌症综合网络(NCCN)老年肿瘤指南详解
2012V1版美国国家癌症综合网络(NCCN)结肠癌指南更新解读
2011年《美国国家癌症综合网络(NCCN)胰腺癌临床实践指南》(中国版)解读
欧洲《恶性胸膜间皮瘤诊疗指南》
学术会议
美国肠外肠内营养学会(ASPEN)
欧洲临床营养与代谢学会(ESPEN)
中华医学会肠外肠内营养学分会(CSPEN)
国际感染病学会(ISID)
美国感染病学会(IDSA)
美国微生物学会(ASM)
美国微生物学会(ASM)
国际人与动物真菌学会(ISHAM)
联系我们
《临床时讯》仅供临床医生及相关专业人士参考,如果您有任何意见或建议,请发邮件至:
© 2012 EDDINGPHARM