非营利性医院中的结构性歧视 社区福利支出
Aaron Hedquist1, David Blumenthal1, Dannie Dai1
1Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA health forum
|February 28, 2025
概括
非营利性医院为社会脆弱和少数群体提供较少的社区福利支出 (CBS). 这表明在免税制度中存在潜在的结构性歧视,加剧了健康差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 非营利性医院为提供社区福利而获得免税.
- 美国社会弱势社区的社区福利支出 (CBS) 的分配还不太清楚.
- 了解CBS分配对于评估公平的社区利益至关重要.
研究的目的:
- 检查社区层面的健康社会决定因素与人均CBS之间的关联.
- 为了识别美国不同社区的CBS分配模式.
- 评估非营利性医院对社区福利分配的公平性.
主要方法:
- 使用美国国税局第990系列税务表格 (2018-2023) 进行横截面研究.
- 设施级的CBS根据住院患者利用量分配给各县.
- 通用线性回归模型用于分析人均CBS与社会决定因素 (SVI,种族/种族,贫困,教育) 之间的关联.
主要成果:
- 分析了美国3140个县的2465家非营利性医院.
- 人均CBS的显著变化;最高五分位数获得了540美元 (SD $ 250),而最低五分位数获得了22美元 (SD $ 16).
- 在非西班牙裔黑人/西班牙裔居民比例较高,教育程度较低,贫困率较高,社会脆弱性指数 (SVI) 分数较高的社区中观察到人均较低的CBS.
结论:
- 非营利性医院CBS是回归分配的,有利于更富裕的白人社区,而不是社会脆弱和少数群体社区.
- 目前的非营利性免税制度可能会通过歧视性分配社区福利来促进健康差异.
- 调查结果强调需要重新评估确保社区利益公平分配的政策,以解决健康不平等问题.
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