Religious Health Care as Community Benefit: Social Contract, Covenant, or Common Good?

The public responsibilities of nonprofit hospitals have been contested since the advent of the 1969 community benefit standard. The distance between the standard's legal language and its implementation has grown so large that the Internal Revenue Service issued a new reporting form for 2008 that is modeled on the Catholic Health Association's guidelines for its member hospitals. This article analyzes the appearance of an emerging moral consensus about community benefits to argue against a strict charity care mandate and in favor of directing efficient care delivery and healthy community initiatives to underserved populations. The analysis turns on three moral conceptions of community benefits, the social contract model of hospital critics and the common good and covenantal models of Catholic and Jewish hospitals.