Community benefit laws, hospital ownership, community orientation activities, and health promotion services

Ginn, Gregory O.; Shen, Jay J.; Moseley, Charles B.

doi:10.1097/hmr.0b013e31819e90e0

Cited by 15 publications

(5 citation statements)

References 22 publications

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“…To date, evidence is mixed regarding whether such inter-related work occurs within communities. 10,14,37,49 This study found evidence that can potentially add clarity to some of the unresolved questions at the nexus of resource allocations across U.S. counties.…”

Section: Discussionmentioning

confidence: 74%

“…Previous research has defined a set of 17 “community health services” that benefit the health of the community at large. 25,37,48-51 We used hospitals’ responses to questions to define a set of 17 community health services. Hospitals responded whether each service was or was not provided; no data were available regarding the scale, scope, or efficiency of the services provided.…”

Section: Methodsmentioning

confidence: 99%

“…35,36 This means that organizations will model their own structures and approaches based off of those found in organizations that are otherwise perceived to be successful organizations. 35,36 In addition to impacting organizational structure, 37,38 isomorphism has been observed to impact organizations’ program and service offerings. 39,40 Under institutional isomorphic theory, governmental health and social service agencies within a community will—through formal or informal mechanisms and networks 12,41 —seek to emulate the service and investment portfolios of other governmental agencies within the community.…”

Section: Methodsmentioning

confidence: 99%

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Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health

McCullough

2019

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Population health improvements can be achieved through work made possible by government spending on health care, public health, and social services. The extent to which spending allocations across these sectors is synergistic with or trade-off against one another is unknown. Achieving a balanced portfolio with multi-sector contributions is key to improving health outcomes. This study tested competing hypotheses regarding achievement of balanced multi-sector resources for health. County-level U.S. Census Bureau data on all local governmental spending measured each county’s average per capita local government spending for public hospitals, public health, social services, and education. American Hospital Association (AHA) Annual Survey data on hospital community health service provision were used to calculate an index of hospital community service provision aggregated to county level by year. County Health Rankings data measured each county’s health outcomes and health factors. Longitudinal mixed-effects regression models (n = 1877 counties) predicted changes in spending for each government spending category based on two sets of predictors ( government spending vs community health services and needs ) from current and prior year. Models account for average spending in each category and county-, state-, and time-trends. Models showed that spending increases in each of the four spending categories examined (public hospitals, public health, social services, and education) were not associated with changes in spending across other categories in current or prior years. For all categories, an increase from baseline spending levels in Year 1 was always significantly associated with an increase from baseline spending level in that same category in Year 2 (ie, spending stayed above baseline in Year 2). Multi-sector initiatives to health outcomes require funding across sectors, yet there was little evidence to suggest that communities that invest in public hospitals, public health, or other social services see commensurate increases in other areas. Underlying funding decisions may reflect strategic decisions within a community to scale up single sectors, constrained resources for multi-sector scale up, or a host of additional factors not measured here.

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Section: Discussionmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health

McCullough

2019

INQUIRY

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“…The AHA Annual Survey collects data about facilities, services, payment, and staffing from 6,218 hospitals across the United States. 26 Data from the AHA Annual Survey have been used to characterize hospitals' community benefits efforts, [27][28][29] and the 2018 version of the survey captures information about hospitals' participation in 11 types of social care programs. 26 Community Benefit Insight provides information about the community benefits spending of tax-exempt hospitals.…”

Section: Methodsmentioning

confidence: 99%

Provision of Social Care Services by US Hospitals

Iott

Anthony

2023

Milbank Quarterly

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Hospitals address population health needs and patients’ social determinants of health by offering social care services. Tax‐exempt hospitals are required to invest in community benefits, including social care services programs, though most community benefits spending is toward unreimbursed health care services. Tax‐exempt hospitals offer about 36% more social care services than for‐profit hospitals. Among tax‐exempt hospitals, those that allocate more resources to community benefits spending offer more types of social care services, but those in states with minimum community benefits spending requirements offer fewer social care services. Policymakers may consider specifically incentivizing community benefits expenditures toward particular social care services, including linking tax exemptions to implementation, utilization, and outcome targets, to more directly help patients. Context Despite growing interest in identifying patients’ social needs, little is known about hospitals’ provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax‐exempt hospitals. Methods National secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state‐level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi‐square and t‐tests comparing for‐profit and tax‐exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax‐exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services. Findings Private US hospitals offered an average of 5.7 types of social care services in 2018. Tax‐exempt hospitals offered about 36% more social care services than for‐profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax‐exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient‐focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services. Conclusions Although tax‐exempt status and increased community benefits spending were associated with increased social care services provision, the observation th...

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“…[11][12][13][14] Since data on hospitals' actual expenditures are frequently not available, some of these indicators have been used as proxies for hospitals' community benefit activities. In this study, we rely on some of the most commonly used indicators of hospitals' charitable activity to evaluate the convergent validity of hospitals' self-reported community benefit expenditures (see Table 1).…”

Section: Indicators Of Charitable Activitymentioning

confidence: 99%

Assessing the Validity of Self-reported Community Benefit Expenditures

Rauscher

Vyzas

2012

Journal of Public Health Management and Practice

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Community benefit laws, hospital ownership, community orientation activities, and health promotion services

Abstract: Managers of acute care hospitals should engage in community orientation activities to maintain their legitimacy, differentiate themselves from other hospitals, avoid regulation, and manage resource dependency on managed-care payers.

Cited by 15 publications

References 22 publications

Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health

Government Health and Social Services Spending Show Evidence of Single-Sector Rather Than Multi-Sector Pursuit of Population Health

Provision of Social Care Services by US Hospitals

Assessing the Validity of Self-reported Community Benefit Expenditures

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