The presence of hospital foundations inside a public healthcare system raises the question of whether they are charitable organisations doing charitable acts and how they differ from state institutions. A charitable act is based on the notion of gift. A gift relationship, compared to a commercial relationship, is founded on sharing and mutual responsibility rather than common interests. Among friends and relatives, giving reveals strong and lively relationships. In modern society, giving also takes place between strangers. It reveals strong community ties. The charitable sector, including hospital foundations, is the most common form of giving among strangers. Those who participate in this sector show a high level of involvement in many sectors of society and have strong community ties. State action takes place irrespective of the quality of community ties, although it ultimately depends on it. Charitable action complements state action. However, state action remains essential since charity is alien to the concepts of justice and equity.

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