Hospital Fair Share Spending

Nonprofit hospitals get big tax breaks. Are they giving back as much as they take?

Nonprofit hospitals are exempt from most taxes, a benefit worth billions of dollars each year. In exchange, hospitals are expected to provide financial assistance to patients and community benefit investments. Examples of community benefits include programs to improve community health such as free clinics, health education programs, subsidized health services, improvements in the social determinants of health, donations to community groups, and more.

However, relatively few nonprofit hospitals spend as much on their communities as they receive in tax breaks. Those hospitals have what we call a Fair Share Deficit. According to the Lown Institute’s most recent findings, 77% of nonprofit hospitals spent less on community investment than their tax exemption in 2020, resulting in a total deficit of $14.2 billion.

2025 report to detail Fair Share Spending across 20 states

The Lown Institute is undertaking a two-year project to assess the Fair Share Spending of hospitals in 20 states, with full results available in 2025. 

This analysis updates our previous work estimating the value of nonprofit hospital tax exemptions and will include a detailed calculation of each element of the tax exemption where applicable, including:

  • federal and state income tax,
  • state and local sales tax,
  • property tax,
  • value of tax-exempt donations, and
  • value of tax-exempt bonds.

This project is supported  through funding from Arnold Ventures.

Media inquiries should be directed to Aaron Toleos, vp of communications, at

More about Fair Share 

Read the 2023 national report on fair share spending from the Lown Institute, including the hospitals with the highest deficits and surpluses in the U.S.

View the Lown Institute’s 2022 analysis of fair share spending in New York City, which found deficits at many of the city’s prestigious hospitals, some over $100 million.

Visit our community benefit policy tracker to learn about activity at the state level to regulate hospital community benefit spending. 

Read our blog “Five things you need to know about community benefits” for an introduction to the topic.

Read our op-ed in Stat News explaining why certain types of community benefits are more meaningful for community health than others.

Visit Lown’s Hospital Index where we rank hospitals using a community benefit metric measuring their spending on financial assistance, Medicaid revenue, and community investment.

Project Team

Vikas Saini, MD, president
Paula Smith, MPH, senior data scientist 
Judith Garber, MPP, senior policy analyst
Noelle Serino, MPH, policy analyst
Carissa Fu, chief of staff