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Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
目前，关于哪些活动和计划构成医院社区福利，尚无专家共识。在中国,在2009年最近的医疗体制改革之后，医院社区福利运动开始受到关注。在美国,美国国税局和非营利性医院部门多年来一直在努力定义社区利益。最近,根据平价医疗法案(ACA)的新“社区福利”要求，非营利性医院进一步开发了这些福利，以符合501(c)(3)免税资格。
德尔菲调查方法用于探索在中国和美国被认为是医院社区利益的活动和/或计划。20名中国学者和19名美国学者，高级医院管理人员和政策制定者被招募为专家，并参加了两轮调查。调查问卷首先在中国使用5分利克特量表对某些医院社区福利活动的支持进行评分；然后将其翻译成英文。在第一轮Delphi之后对问卷进行了修改。经过两轮调查，研究小组只接受至少70%支持率的回答。
德尔福调查结果显示，中国和美国的专家对68.75%的六氯代苯活动和/或项目达成一致，包括应急准备,社会公益活动,坏账/医疗补助缺口，救灾,环境保护,健康促进和教育，教育和研究，慈善关怀,具有正外部性的医疗服务，提供低利润服务，和滑动规模的费用。
在中国,专家认为，医疗保健是一项“人权”，政府负有确保公民获得负担得起的医疗保健的主要责任。同时,医疗保健在美国被认为是一种商品，和许多美国人，特别是那些脆弱和低收入的人，无法负担和获得所需的医疗保健服务。尽管美国政府认识到社区福利的重要性，并在ACA中加入了一个章节，概述了非营利性医院的新社区福利要求，有必要就非营利医院应提供的社区福利的金额和类型发布具体政策，以获得免税地位。
德尔菲调查方法用于探索在中国和美国被认为是医院社区利益的活动和/或计划。20名中国学者和19名美国学者，高级医院管理人员和政策制定者被招募为专家，并参加了两轮调查。调查问卷首先在中国使用5分利克特量表对某些医院社区福利活动的支持进行评分；然后将其翻译成英文。在第一轮Delphi之后对问卷进行了修改。经过两轮调查，研究小组只接受至少70%支持率的回答。
德尔福调查结果显示，中国和美国的专家对68.75%的六氯代苯活动和/或项目达成一致，包括应急准备,社会公益活动,坏账/医疗补助缺口，救灾,环境保护,健康促进和教育，教育和研究，慈善关怀,具有正外部性的医疗服务，提供低利润服务，和滑动规模的费用。
在中国,专家认为，医疗保健是一项“人权”，政府负有确保公民获得负担得起的医疗保健的主要责任。同时,医疗保健在美国被认为是一种商品，和许多美国人，特别是那些脆弱和低收入的人，无法负担和获得所需的医疗保健服务。尽管美国政府认识到社区福利的重要性，并在ACA中加入了一个章节，概述了非营利性医院的新社区福利要求，有必要就非营利医院应提供的社区福利的金额和类型发布具体政策，以获得免税地位。
