Luis Maximilian TrenkerGemeinnützigkeitsrechtliche Anforderungen an die Steuerverschonung von Krankenhäusern

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Non-profit law requirements for tax exemptions for hospitals

Creating and maintaining an effective and sustainable healthcare system is one of the core tasks of the state. The treatment of patients in hospitals is an essential part of this healthcare system. Historically, the state has primarily left the provision of hospital services to independent providers.

Around half of all hospitals in Germany are run as non-profit institutions. These (non-profit) hospitals are subject to the special requirements of non-profit tax law. This exempts activities of private actors that promote the common good from income taxation and makes it possible to issue qualified certificates for third-party donation deductions.

However, the privileged status of charitable actors is accompanied by special obligations. They must undertake to pursue the tax-privileged purposes exclusively, directly and selflessly. This seemingly simple basic requirement develops into a complex and difficult set of regulations, the design of which requires continuous justification in the existing field of tension between fundamental rights and state intervention.

This paper therefore deals with the question of whether and to what extent the provisions of non-profit tax law are still suitable for meeting the constitutional standards for the taxation of non-profit hospitals. In particular, there is a conflict between the - welfare state-based - tax incentives for hospitals, the permissibility of a plurality of providers and the basic principle of taxation according to economic performance.

The result of this question is summarized in 99 theses. These clearly show the inconsistencies, discrepancies and system breaks in the non-profit regulations. Wherever it appeared necessary, proposals for appropriate changes to the legal regulations were developed.

However, it is also shown where no change to the legal norms appears necessary and instead a different interpretation of these norms is sufficient.

In addition to the many criticisms of the provisions of the tax law on non-profit organizations, the legal norms and legal views that are in line with the constitutional assessment standards are also agreed with.