Notwithstanding passage of the Affordable Care Act (ACA) in 2010, the debate over the deontological nature of health care in the United States continues. Reflecting opposing views on the issue, the provision of private (i.e., non-governmental), institutional health care in this country has evolved into a limited, binary choice of organizational forms: that is, nonprofit hospitals provide care ostensibly in order to maximize the public good; for-profit hospitals provide care as a means to maximize owner profit. Over time, however, developments in medical science, technology, and business economics have resulted in increased commercialization of both organizational forms, blurring these traditional distinctions. Increasingly, questions are being raised about the appropriateness of continuing to afford tax-exemption to what may be, in many instances, only nominally “nonprofit” business enterprises. The ACA is expected to bring a number of systemic changes to the larger health care delivery system in which these organizations operate. Among these changes is a significant increase in the number of Americans with health insurance. This increase will reduce the need for charity care – the primary rationale for the initial development of nonprofit hospitals and the historical justification for their continued tax-exemption. In addition, the ACA contains multiple new imperatives for improving the value, quality, efficiency, and accountability of health care services with systems-based care management applied through integrated * The author wishes to acknowledge and thank the following individuals for their time and assistance in reviewing and commenting on this article: Shawn Mathis, J.D., L.L.M.; H. Barry Holt, Ph.D., J.D.; Susan L. Watchman, M.P.H., J.D.; and, Professor John D. Blum, M.H.S., J.D. http://dx.doi.org/10.18060/18961 104 INDIANA HEALTH LAW REVIEW Vol. 12:1 care models. Such models necessarily will require greater alignment of, and cooperation between, stakeholders in multiple delivery systems—nonprofit and for-profit alike. Collectively, these changes suggest a role for a new organizational paradigm to supplement the traditional binary choice between nonprofit and for-profit corporations as a preferred vehicle for institutional health care delivery. A conceptually-new business entity that can reconcile promotion of the public good with limited profit-seeking – accomplished through a legally-enforceable organizational form that acknowledges the legitimate interests of multiple stakeholders while mandating both mission primacy and fiduciary obligation – may well be better-suited to the modern environment and new imperatives of the ACA.
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Mar 31, 2019
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