Defining hospital community benefit activities using Delphi technique: A comparison between China and the United States


Autoři: Aijun Xu aff001;  Hossein Zare aff002;  Xue Dai aff002;  Yuanxi Xiang aff004;  Darrell J. Gaskin aff002
Působiště autorů: School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China aff001;  Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States aff002;  University of Maryland University College, Health Services Management, Adelphi, Maryland, United States aff003;  School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225243

Souhrn

Introduction

Currently there is no expert consensus regarding what activities and programs constitute hospital community benefits. In China, the hospital community benefit movement started gaining attention after the recent health care system reform in 2009. In the United States, the Internal Revenue Service and the nonprofit hospital sector have struggled to define community benefit for many years. More recently, under the Affordable Care Act (ACA)’s new “community benefit” requirements, nonprofit hospitals further developed these benefits to qualify for 501(c)(3) tax exempt status.

Methods

The Delphi survey method was used to explore activities and/or programs that are considered to be hospital community benefits in China and the United States. Twenty Chinese and 19 American of academics, senior hospital managers and policy makers were recruited as experts and participated in two rounds of surveys. The survey questionnaire was first developed in China using the 5-point Likert scale to rate the support for certain hospital community benefits activities; it was then translated into English. The questionnaires were modified after the first round of Delphi. After two rounds of surveys, only responses with a minimum of 70 percent support rate were accepted by the research team.

Results

Delphi survey results show that experts from China and the U.S. agree on 68.75 percent of HCB activities and/ or programs, including emergency preparedness, social benefit activities, bad debt /Medicaid shortfall, disaster relief, environmental protection, health promotion and education, education and research, charity care, medical services with positive externality, provision of low profit services, and sliding scale fees.

Conclusions

In China, experts believe that healthcare is a “human right” and that the government has the main responsibility of ensuring affordable access to healthcare for its citizens. Meanwhile, healthcare is considered a commodity in the U.S., and many Americans, especially those who are vulnerable and low-income, are not able to afford and access needed healthcare services. Though the U.S. government recognized the importance of community benefit and included a section in the ACA that outlines new community benefit requirements for nonprofit hospitals, there is a need to issue specific policies regarding the amounts and types of community benefits non-profit hospitals should provide to receive tax exemption status.

Klíčová slova:

Critical care and emergency medicine – Health economics – Health education and awareness – Health services research – China – Medical education – Medical services – Disaster aid


Zdroje

1. Bazzoli GJ, Clement JP, Hsieh HM. Community Benefit activities of private, nonprofit hospitals. J Health Polit Policy Law. 2010;35(6):999–1026. doi: 10.1215/03616878-2010-036 21451160

2. Singh SR, Bakken E, Kindig DA, Young GJ. Hospital community benefit in the context of the larger public health system: A state-level analysis of hospital and governmental public health spending across the United States. J Public Health Manage Pract. 2016;22(2):164–74.

3. Fleischhacker SE, Ramachandran G. The hospital community benefit program: Implications for food and nutrition professionals. Nutr Today. 2016;51(4):191–3. doi: 10.1097/NT.0000000000000165 27773946

4. Xu A-j, Shi Y-j, Yang X-w, Zhou C-h. Study to determine the behavior expressionof hospitas’l social responsibilities. Chinese jouranl hospital administrative 2012;28(9):651–5.

5. Song PH, Lee SY, Alexander JA, Seiber EE. Hospital ownership and community benefit: looking beyond uncompensated care. Journal of healthcare management / American College of Healthcare Executives. 2013;58(2):126–41; discussion 41–42. 23650697

6. Qingyue M, Shenglan T. Universal health care coverage in China: challenges and opportunities. Procedia-Social and Behavioral Sciences. 2013;77:330–40.

7. Mossialos E, Wenzl M, Osborn R, Sarnak D. 2015 international profiles of health care systems. Canadian Agency for Drugs and Technologies in Health. Retrieved August 6, 2019. https://www.commonwealthfund.org/sites/default/files/documents/_media_files_publications_fund_report_2016_jan_1857_mossialos_intl_profiles_2015_v7.pdf.

8. Blumenthal D, Hsiao W. Privatization and its discontents—the evolving Chinese health care system. Mass Medical Soc; 2005.

9. Sussmuth-Dyckerhoff C, Wang J. China’s Health Care Reforms. Health International 2010, Number 10:55–67. Retrieved August 6, 2019 from: https://wwwmckinseycom/~/media/mckinsey/dotcom/client_service/healthcare%20systems%20and%20services/health%20international/hi10_china_healthcare_reformashx.

10. Liu G, Huang J. Global Hospital Managment Survey—China (updated 2014). Retrieved March 5, 2019. https://wwwhbsedu/faculty/conferences/2014-world-management-survey/Documents/GlobalHospital_Management_Survey_Horakpdf.

11. Yu H. Universal health insurance coverage for 1.3 billion people: What accounts for China’s success? Health policy. 2015;119(9):1145–52. doi: 10.1016/j.healthpol.2015.07.008 26251322

12. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. The Lancet. 2012;379(9818):833–42.

13. Yip W, Hsiao W. Harnessing the privatisation of China’s fragmented health-care delivery. The Lancet. 2014;384(9945):805–18.

14. Li L. Review of advances in the new health system reform. Chinese Health Economics. 2012;31(1):5–9.

15. Ministry of Health (MOH). Third-tier hospital performance standard guidelines. 2011. Retrieved March 5, 2019. http://www.nhfpc.gov.cn/yzygj/s3585u/201112/2e2dced4731f46f5bdabd3dcaff83684.shtml

16. American Hospital Association (AHA). Fast Facts on US Hospitals (Updated January 2017). Retrieved April 21, 2019. http://www.aha.org/research/rc/stat-studies/fast-facts.shtml.

17. Corrigan J, Fisher E, Heiser S. Hospital community benefit programs: Increasing benefits to communities. JAMA. 2015;313(12):1211–2. doi: 10.1001/jama.2015.0609 25643208

18. Internal Revenue Service (IRS). (January, 2017). Exemption requirements—501(c)(3) organizations (updated 26-jan-2017). Retrieved April 21, 2019. https://www.irs.gov/charities-non-profits/charitable-organizations/exemption-requirements-section-501-c-3-organizations.

19. Larner L. Health policy brief: Nonprofit hospitals’ community benefit requirements Retrieved March 5, 2019. http://healthaffairs.org/blog/2016/02/25/health-policy-brief-nonprofit-hospitals-community-benefit/.

20. Steinwald B. Nonprofit hospitals; variation in standards and guidance limits: Comparison of how hospitals meet community benefit requirements: DIANE Publishing; 2008.

21. Internal Revenue Service (IRS). Schedule H (Form 990), Hospitals accessed. irs.gov; 2016 [updated 21-Sep-2016. Retrieved August 6, 2019. https://www.irs.gov/uac/about-schedule-h-form-990.

22. Boddie-Willis CL, Brow AL, Folkemer DC, Milligan C, Mueller CH, Somerville MH, et al. Hospital Community Benefits After the ACA: The Emerging Federal Framework. 2011.

23. Folkemer D, Spicer L, Mueller C, Somerville M, Brow A, Milligan C. Hospital community benefits after the ACA: The emerging federal framework (Issue Brief). Baltimore, MD: The Hilltop Institute, UMBC. 2011.

24. Zimmerman D. Nonprofit organizations, social benefits, and tax policy. National Tax Journal. 1991;44(3):341–9.

25. Nicholson S, Pauly MV, Burns LR, Baumritter A, Asch DA. Measuring community benefits provided by for-profit and nonprofit hospitals. Health Affairs. 2000;19(6):168–77. doi: 10.1377/hlthaff.19.6.168 11192400

26. Ren-zong Q. Chinese Academy of Social Sciences, Beijing 100732, China; On hospital’s social responsibilities: from the perspective of ethics [J]. Medicine & Philosophy (Humanistic & Social Medicine Edition). 2006;6.

27. Ginn GO, Moseley CB. The impact of state community benefit laws on the community health orientation and health promotion services of hospitals. J Health Polit Policy Law. 2006;31(2):321–44. doi: 10.1215/03616878-31-2-321 16638834

28. SSCO. Shanghai spiritual civilization office, announcement of Shanghai organizations of excellence social responsibility reporting guidelines. (updated February, 2012). Retrieved August 6, 2019. http://www.wmsh.gov.cn/gg/201203/t20120301_95681.htm [Chinese].

29. Centers for Medicare & Medicaid Services (CMS). Form CMS-2552-10: Worksheet S-10—Hospital Uncompensated and Indigent Care Data. Centers for Medicare & Medicaid Services; 2015. Retrieved August 6, 2019. https://www.costreportdata.com/instructions/Instr_S100.pdf.

30. American Hospital Association (AHA). Statement of the American Hospital Association submitted to the Committee on Finance of the United States Senate on Bipartisan Tax Reform. AHA; 2015. Retrieved August 6, 2019. http://www.aha.org/advocacy-issues/testimony/2015/150415-statement-taxreform.pdf.

31. Catholic Health Association (CHA). Community benefit overview. The Catholic Health Association of the United States. CHA; 2017. Retrieved August 6, 2019. http://www.chausa.org/.

32. Hai-chao L. Study on the Definition and Its Enhancement Options of Public-Interests Orientation of Public Hospitals. Chinese Health Economics. 2012;31(1):10–2.

33. Weijun M. An Approach to the Connotation and Denotation of Public Welfare Nature of Public Hospitals. Medicine and Society. 2009;4:013.

34. AHA. American Hospital Association. AHA guidance on reporting of community benefit. 2006. Retrieved August 6, 2019. http://www.aha.org/content/00-10/061113cbreporting.pdf.

35. Xu A-j, Shi Y-j, Yang X-w. Study on classification of hospital community benefit behaviors. China Pharmacy. 2012;23(41):3853–4.

36. Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. International journal of forecasting. 1999;15(4):353–75.

37. Keeney S, McKenna H, Hasson F. The Delphi technique in nursing and health research: John Wiley & Sons; 2010.

38. Hansen K. Attitudes to evidence in acupuncture: an interview study. Medicine, Health Care and Philosophy. 2012;15(3):279–85.

39. Qualtrics. Security Statement. Retrieved May 2, 2018. https://www.qualtrics.com/security-statement/.

40. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. Journal of advanced nursing. 2000;32(4):1008–15. 11095242

41. Verkade P-J, van Meijel B, Brink C, van Os-Medendorp H, Koekkoek B, Francke AL. Delphi-research exploring essential components and preconditions for case management in people with dementia. BMC geriatrics. 2010;10(1):54.

42. Akins RB, Tolson H, Cole BR. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC medical research methodology. 2005;5(1):37.

43. Ministry of Health (MOH). Hospital management appraisal guide. Retrieved March 5, 2019. http://www.moh.gov.cn/mohyzs/s3585/200806/36242.shtml.

44. Ministry of Health (MOH). Second-tier hospital performance standard guidelines-2012. Retrieved March 5, 2019. http://www.nhfpc.gov.cn/cmsresources/mohylfwjgs/cmsrsdocument/doc14985.pdf.

45. Xu A. Behaviors of public hospitals’ social responsibilities based on the content analsis. Nanjing Social Science 2011:(4):146–151. 2011.

46. Lin L, Ashkenazi I, Dorn BC, Savoia E. The public health system response to the 2008 Sichuan province earthquake: a literature review and interviews. Disasters. 2014;38(4):753–73. doi: 10.1111/disa.12079 25196335

47. Gale L. Nonprofit salaries for healthcare executives on the rise. Healthcare Dive; 2017. Retrieved August 6, 2019. http://www.healthcaredive.com/news/nonprofit-salaries-for-healthcare-executives-on-the-rise/437566/.

48. Landen R. Another year of pay hikes for non-profit hospital CEOs. ModernHealthcare; 2014. Retrieved August 6, 2019.: http://www.modernhealthcare.com/article/20140809/MAGAZINE/308099987.

49. Lei J, Sockolow P, Guan P, Meng Q, Zhang J. A comparison of electronic health records at two major Peking University Hospitals in China to United States meaningful use objectives. BMC medical informatics and decision making. 2013;13(1):96.

50. Kalisch BJ, Liu Y. Comparison of nursing: China and the United States. Nursing Economics. 2009;27(5):322. 19927447

51. Yi Z-M, Zhao R-S, Zhai S-D, Yang L, Hu Y-F, Yang Y-H, et al. Comparison of US and Chinese pharmacy education programs. American Journal of Health-System Pharmacy. 2014;71(5):425–9. doi: 10.2146/ajhp130611 24534598

52. Daemmrich A, Mohanty A. Healthcare reform in the United States and China: pharmaceutical market implications. Journal of pharmaceutical policy and practice. 2014;7(1):9. doi: 10.1186/2052-3211-7-9 25097759


Článek vyšel v časopise

PLOS One


2019 Číslo 11