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Hospital Community Benefit in the Context of the Larger Public Health System: A State-Level Analysis of Hospital and Governmental Public Health Spending Across the United States

Singh, Simone R. PhD; Bakken, Erik MPAff; Kindig, David A. MD, PhD; Young, Gary J. JD, PhD

Journal of Public Health Management and Practice: March/April 2016 - Volume 22 - Issue 2 - p 164–174
doi: 10.1097/PHH.0000000000000253
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Context: Achieving meaningful population health improvements has become a priority for communities across the United States, yet funding to sustain multisector initiatives is frequently not available. One potential source of funding for population health initiatives is the community benefit expenditures that are required of nonprofit hospitals to maintain their tax-exempt status.

Objective: In this article, we explore the importance of nonprofit hospitals' community benefit dollars as a funding source for population health.

Design: Hospitals' community benefit expenditures were obtained from their 2009 IRS (Internal Revenue Service) Form 990 Schedule H and complemented with data on state and local public health spending from the Association of State and Territorial Health Officials and the National Association of County & City Health Officials. Key measures included indicators of hospitals' community health spending and governmental public health spending, all aggregated to the state level. Univariate and bivariate statistics were used to describe how much hospitals spent on programs and activities for the community at large and to understand the relationship between hospitals' spending and the expenditures of state and local health departments.

Results: Tax-exempt hospitals spent a median of $130 per capita on community benefit activities, of which almost $11 went toward community health improvement and community-building activities. In comparison, median state and local health department spending amounted to $82 and $48 per capita, respectively. Hospitals' spending thus contributed an additional 9% to the resources available for population health to state and local health departments. Spending, however, varied widely by state and was unrelated to governmental public health spending. Moreover, adding hospitals' spending to the financial resources available to governmental public health agencies did not reduce existing inequalities in population health funding across states.

Conclusions: Hospitals' community health investments represent an important source for public health activities, yet inequalities in the availability of funding across communities remain.

This article explores the importance of nonprofit hospitals' community benefit dollars as a funding source for population health.

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (Dr Singh); Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (Mr Bakken and Dr Kindig); and Northeastern University Center for Health Policy and Healthcare Research, and Northeastern University D'Amore-McKim School of Business and Bouve College of Health Sciences, Boston, Massachusetts (Dr Young).

Correspondence: Simone R. Singh, PhD, Department of Health Management and Policy, University of Michigan School of Public Health, 1420 Washington Heights, M3533 SPH II, Ann Arbor, MI 48109 (singhsim@umich.edu).

Partial funding for this study was provided by the Robert Wood Johnson Foundation.

The authors declare no conflicts of interest.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.