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This paper examines the impact of tax policies on the contributions of nonprofit organizations and social enterprises to health equity in the US and China. Through cross-national case comparisons, the study finds that US market-oriented healthcare and law-based tax advantages encourage nonprofit participation but create accountability challenges, while China's state-led system and restricted fiscal incentives ensure alignment with national health goals but limit autonomy and innovation. The study suggests designing tax policies that balance accountability and flexibility to improve health equity.
Tax policies significantly influence the behavior and impact of nonprofit organizations and social enterprises in healthcare, affecting their ability to address health equity.
Nonprofit organizations and social enterprises have been regarded as an important solution to inequalities in healthcare systems around the world, yet their actual contributions are often contingent upon the governance regimes. Tax policies, such as exemptions, deductions and preferential treatment, support the development and operation of nonprofits while shaping their organizational behaviors in the medical systems. Through cross-national and within-country case comparisons, this paper shows that: 1) in the United States, the market-oriented healthcare system and law-based tax advantages encourage nonprofit and hybrid organizational participation, yet create challenges for accountability and necessitates; 2) in China, the state-led healthcare system and restricted fiscal incentives to recognized nonprofits ensure alignment to national health goals and effectiveness, though at the cost of autonomy and innovation. Countries need to design tax policies that are sensitive to local healthcare demands and find a balance between accountability and flexibility, to make sure that fiscal incentives translate into visible advances in health equity.
