Provision of Community Benefits by Tax-Exempt U.S. Hospitals

Abstract

In 2009, tax-exempt hospitals varied markedly in the level of community benefits provided, with most of their benefit-related expenditures allocated to patient care services. Little was spent on community health improvement.

From surviving to community benefit: A proposed rural health services research agenda

“…Of this amount, only 5% went to community health activities. Further, it is shown that observed wide variations in community benefit expenditures were not accounted for by variables that define: 1) community, 2) institutional, or 3) market attributes [44] . Since community, institutional, or market characteristics are not drivers of a facility's community benefit expenditure levels, it follows that a hospital's level of community benefit offerings are a matter of facility discretion.…”

“…While implementation of either or both sets of cost-reduction recommendations will have an adverse impact on rural health services [47] , the cost-reduction emphasis is poorly timed. They diminish the value of needed policy, administrative, service delivery research opportunities.…”

“…They diminish the value of needed policy, administrative, service delivery research opportunities. Rather than arguing about the present-day relevance of the 1997 Medicare CAH program [44,45] by defining the problem as higher than necessary reimbursement, the CHNA requirement, once researched, is a priority policy and administrative decision-support tool.…”

Tax-Exempt Hospitals and Community Benefit: New Directions in Policy and Practice

“…Much of this research has provided only a partial picture of tax-exempt hospitals' community benefits, mainly because of disagreement regarding what should count as a community benefit as well as owing to the lack of adequate data (11,50). A recent study, national in scope and based on 2009 IRS tax filings, found that tax-exempt hospitals devoted an average of 7.5% of their expenditures to community benefits as defined by the IRS (73). Of these expenditures, more than 85% went toward charity care, government payer payment shortfalls, and subsidized health services.…”

Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

“…Nonprofit hospital community benefit activities are those that are required by the Internal Revenue Service (IRS) of nonprofit hospitals to justify their nonprofit status (Rosenbaum & Margulies, 2011). Nonprofit hospital community benefit activities have traditionally focused on the provision of charity care but a number of changes associated with the Patient Protection and Affordable Care Act (ACA) have pushed nonprofit hospitals to focus more on population and public health (Rosenbaum & Margulies, 2011;Young, Chou, Alexander, Lee, & Raver, 2013).…”