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Key Points: Question: What is the total tax benefit received by US nonprofit hospitals? Findings: Analyzing data from Medicare Cost Reports, a total of 2927 US nonprofit hospitals received a $37.4 billion total tax benefit in 2021. Tax benefit varies widely across states and is highly concentrated among a small number of hospitals. More than half of the total tax benefit was received at the state and local levels. Meaning: Policy efforts to strengthen nonprofit hospitals' taxpayer accountability are likely more effective when pursued at the local level. A standardized estimation road map is provided for various stakeholders to value tax benefit for valuation and reporting purposes. Importance: Nonprofit hospitals are under increasing scrutiny to justify the generous tax benefit they receive due to their tax-exempt status. Quantifying the value of the tax benefit they receive at the federal, state, and local levels is critical for designing informed public health policies and ensuring nonprofit hospitals' taxpayer accountability. Objective: To estimate the financial benefit that nonprofit hospitals derive from their tax-exempt status and assess how the benefit is distributed across state and local communities. Design, Setting, and Participants: Using methodologies and measures consistent with current tax law and practice and data from 2021 Medicare Cost Reports, this study calculated the total financial benefit from nonprofit hospitals' tax-exempt status for all US nonprofit hospitals with the required Cost Reports data. Main Outcomes and Measures: Nonprofit hospitals' total tax benefit, which equals the sum of federal and state income tax, sales tax, property tax, the fair market value of charitable contributions from donors, savings from tax exemptions on issued bonds, and federal unemployment tax. Results: A total of 2927 US nonprofit hospitals received a $37.4 billion total tax benefit in 2021 from federal income tax ($11.5 billion; 31%), sales tax ($9.1 billion; 24%), property tax ($7.8 billion; 21%), state income tax ($3.7 billion; 10%), charitable contributions ($3.2 billion; 8%), bond financing ($2.1 billion; 6%), and federal unemployment tax ($200 million; <1%). Tax benefit varied substantially across states, from $25 098 (Delaware) to $159 464 (Massachusetts) per hospital bed and from $19 (Alabama) to $275 (Massachusetts) per capita. Tax benefit was highly concentrated, with 7% (n = 212) of hospitals accounting for half of the total amount. Conclusion and Relevance: This study highlights the wide variation of nonprofit hospitals' tax benefit across states, its high concentration among a small number of hospitals, and the primary role played by state and local taxes. Policy efforts to strengthen nonprofit hospitals' taxpayer accountability are likely to be more effective when pursued at the local level. The detailed standardized estimation road map can be used by various stakeholders to estimate tax benefit for external valuation and reporting purposes, updated as laws change, and improved upon as better data sources become available. This study uses data from Medicare Cost Reports to investigate the financial benefit US nonprofit hospitals receive from their tax-exempt status and outlines a standardized estimation methodology that can be replicated at the state and local levels. [ABSTRACT FROM AUTHOR]

This study evaluates the characteristics of generic active pharmaceutical ingredients (APIs) used to manufacture drugs with shortages in the US and facilities producing APIs worldwide. [ABSTRACT FROM AUTHOR]

This study compares Medicare and patient spending for dual over-the-counter and prescription drugs with their over-the-counter cash prices. [ABSTRACT FROM AUTHOR]

Context: People with type 2 diabetes (T2D) have higher risks of cancer incidence and death. Objective: We aimed to evaluate the relationship between dietary and physical activity–based lifestyle intervention and cancer outcomes among prediabetes and T2D populations. Methods: We searched for randomized controlled trials with at least 24 months of lifestyle interventions in prediabetes or T2D populations. Data were extracted by pairs of reviewers and discrepancies were resolved by consensus. Descriptive syntheses were performed, and the risk of bias was assessed. Relative risks (RRs) and 95% CIs were estimated using a pairwise meta-analysis with both a random-effects model and a general linear mixed model (GLMM). Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework, and trial sequential analysis (TSA) was conducted to assess if current information is enough for definitive conclusions. Subgroup analysis was performed by glycemic status. Results: Six clinical trials were included. Among 12 841 participants, the combined RR for cancer mortality comparing lifestyle interventions with usual care was 0.94 (95% CI, 0.81-1.10 using GLMM and 0.82-1.09 using random-effects model). Most studies had a low risk of bias, and the certainty of evidence was moderate. TSA showed that the cumulative Z curve reached futility boundary while total number did not reach detection boundary. Conclusion: Based on the limited data available, dietary and physical activity–based lifestyle interventions had no superiority to usual care on reducing cancer risk in populations with prediabetes and T2D. Lifestyle interventions focused on cancer outcomes should be tested to better explore their effects. [ABSTRACT FROM AUTHOR]