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Non-charitable non-profit organizations in Canada enjoy tax-exempt status, but the rationale for exemption and the policy goals have been poorly articulated from inception. The empirical data suggest that the major sources of revenue for the subsector are commercial in nature, rather than donative, belying some of the vague assumptions underlying exemption. Given the commercial nature of a large number of these organizations, and the lack of readily available information on exactly what these organizations are doing, more information is needed in order to maintain tax equity between commercial and non-profit organizations. The policy goals for the exemption also need to be articulated.

Using the National Academy of State Health Policy Hospital Cost Tool, we compared changes in hospital profits with changes in hospitals' charity care and cash reserves between 2012 and 2019. We estimated substantial growth in nonprofit hospital operating profits and cash reserves in this period but no corresponding increase in charity care.

The federal government encourages public support for charitable activities by allowing people to deduct donations to tax-exempt organizations on their income tax returns. Tax-exempt hospitals are major beneficiaries of this policy because it encourages donations to the hospitals while shielding them from federal and state tax liability. In exchange, these hospitals must engage in community benefit activities, such as providing care to indigent patients and participating in Medicaid. The congressional Joint Committee on Taxation estimated the value of the nonprofit hospital tax exemption at $12.6 billion in 2002-a number that included forgone taxes, public contributions, and the value of tax-exempt bond financing. In this article we estimate that the size of the exemption reached $24.6 billion in 2011. The Affordable Care Act (ACA) brings a new focus on community benefit activities by requiring tax-exempt hospitals to engage in communitywide planning efforts to improve community health. The magnitude of the tax exemption, coupled with ACA reforms, underscores the public's interest not only in community benefit spending generally but also in the extent to which nonprofit hospitals allocate funds for community benefit expenditures that improve the overall health of their communities.

US nonprofit hospitals are required by law to have a charity care policy, but hospitals have significant discretion in determining specific eligibility criteria. Using a novel national database, this analysis revealed that nonprofit hospitals have chosen widely varying charity care eligibility guidelines. Among hospitals that offered free care, income limits ranged from 41 percent to 600 percent of the federal poverty guideline. Many hospitals considered assets when determining eligibility for charity care, and a significant minority also had residency requirements and restrictions for insured patients. Hospitals generally allowed charity care in cases of hardship, with a median cutoff of a given hospital bill being 20 percent of the patient's income. Hospitals in counties with lower levels of poverty and uninsurance had more generous eligibility policies. The wide variation in requirements for hospital financial assistance poses barriers to equitable access to care.

In 2014, the Japanese government introduced the Nippon Individual Savings Account (NISA) to encourage tax-exempt investment and asset accumulation. In January 2024, the NISA underwent significant restructuring to boost household savings in financial asset investments. Taking advantage of the launch of the revamped NISA, we analyzed data collected in late 2022 of 95,632 active investors in a leading securities company to explore their preferences in the previous NISA. Notably, investors exhibit a preference for installment NISA over ordinary NISA, indicating an inclination for long-term capital establishment through gradual investments in secure financial assets. Regression analysis reveals that installment NISA investors are typically female, older, married, or divorced, have lower educational qualifications, engage in part-time employment, have higher incomes, display risk aversion, maintain larger asset balances, and adopt long-term perspectives. By contrast, those favoring ordinary NISA tend to be male, young, married, and financially literate and to have lower incomes, higher asset balances, and shorter-term perspectives. This study advocates maintaining both NISA types, increasing the annual and total investment limits, and eliminating tax exemption periods. These measures would be advantageous for tax savings and capital formation. However, a robust financial education campaign is emphasized to encourage individuals to invest in financial assets, breaking the tradition of keeping funds idle.

During the past decade, numerous congressional bills and amendments have attempted to curtail lobbying by nonprofit organizations that receive federal grants. These policy efforts grow out of an assumption that federal funds are encouraging advocacy at levels that are excessive and encourage additional government spending. Using survey data on more than 700 organizations based in Washington, DC, this article tests this assumption. The data show that for the most part, organizations receiving federal grants and contracts lobby no more frequently than similar organizations that do not receive such benefits. The exception is contacting federal agencies, which charitable organizations receiving federal funds do slightly more often than similar organizations without such funds. A multivariate analysis assesses federal funding together with other variables theorized to affect lobbying—federal tax status, resource levels, and the nature of the lobbying issue—confirming that while these other variables affect lobbying levels, federal funding does not.

The tax-exempt status of nonprofit hospitals has received increased attention from policymakers interested in examining the value they provide instead of paying taxes. We use 2012 data from the Internal Revenue Service (IRS) Form 990, Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports, and American Hospital Association’s (AHA) Annual Survey to compare the value of community benefits with the tax exemption. We contrast nonprofit’s total community benefits to what for-profits provide and distinguish between charity and other community benefits. We find that the value of the tax exemption averages 5.9% of total expenses, while total community benefits average 7.6% of expenses, incremental nonprofit community benefits beyond those provided by for-profits average 5.7% of expenses, and incremental charity alone average 1.7% of expenses. The incremental community benefit exceeds the tax exemption for only 62% of nonprofits. Policymakers should be aware that the tax exemption is a rather blunt instrument, with many nonprofits benefiting greatly from it while providing relatively few community benefits.

Objectives. To identify how US tax-exempt hospitals are progressing in regard to community health needs assessment (CHNA) implementation following the Patient Protection and Affordable Care Act. Methods. We analyzed data on more than 1500 tax-exempt hospitals in 2013 to assess patterns in CHNA implementation and to determine whether a hospital’s institutional and community characteristics are associated with greater progress. Results. Our findings show wide variation among hospitals in CHNA implementation. Hospitals operating as part of a health system as well as hospitals participating in a Medicare accountable care organization showed greater progress in CHNA implementation whereas hospitals serving a greater proportion of uninsured showed less progress. We also found that hospitals reporting the highest level of CHNA implementation progress spent more on community health improvement. Conclusions. Hospitals widely embraced the regulations to perform a CHNA. Less is known about how hospitals are moving forward to improve population health through the implementation of programs to meet identified community needs.