Controversies in Philanthropy: FSSO 119-100 Fall 2021

Ethical Dilemmas in Nonprofit Healthcare Funding








 

According to the Internal Revenue Service (IRS), a grant by a private foundation is Earmarked if it’s, “given under an agreement (oral or written) that the grant will be used for specific purposes.” At base level, the process of earmarking involves separating all or a portion of total revenue—or revenue from a tax or group of taxes—and allocating it to a designated purpose. Nonprofit organizations use earmarks to receive government aid that’s difficult to get through traditional competitive bidding. However, concern has been raised that earmarks are a means for members of Congress and private businesses to direct money toward personal projects. For-profit companies have created new charities for the sole purpose of receiving federal earmarked grants. In a more subtle manner, some companies have been caught channeling money to businesses through established nonprofits (especially universities). According to Pablo Eisenberg, a senior fellow at the Georgetown Public Policy Institute, explains that, “Nonprofit groups are to be created only to promote public interest, not just as receptacles to accept government aid for corporate interests.” Evidently, charitable groups that channel large proportions of their earmarked funds to for-profit companies are not supporting public benefit. 

Regarding earmarking and health, the World Health Organization (WHO) explains that it is increasingly used as an instrument of public health policy and has become a large part of the global discussion on domestic resource mobilization for health—especially for countries transitioning from donor support to achieve health system goals. As of 2017, at least 80 countries earmark for health. Despite the prevalence of earmarked funds in global health policy, few studies have examined empirical evidence of earmarking policies and which country contexts are conducive to the beneficial use of earmarking. To this end, the WHO developed the paper Earmarking for Health, in part, as a tool to help authorities consider important factors before deciding whether to implement earmarking. The WHO research finds that the success of earmarking in healthcare depends on a country's political priorities and budget processes; in most cases, earmarking funds is unlikely to bring a significant and sustained increase in the priority placed on health in a government’s federal budget. Furthermore, earmarked funds introduce rigidity into the budget process, and the inefficiencies in some cases are severe. As seen in the TED video, Dr. Andrew Bastawrous explains the obstacles he and his wife faced due to restrictions imposed by earmarked funds, “And by the ‘wrong diseases,’ I mean conditions for which funding hadn’t been earmarked. Earmarking may seem like smart business or smart philanthropy on paper, but it doesn’t make any sense when you’re looking the person in the eye. Yet, this is how we deliver healthcare to millions of people across the world.” Dr. Bastawrous notes that these situations were common every day during his work in Kenya. WHO adds that earmarking has been found most effective with “broad expenditure purposes” and “more flexible revenue-expenditure links” put in place. This way, philanthropic organizations have the ability to shape their funds based on the needs of their patients.

This page has paths:

This page references: