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State Laws and Nonprofit Hospital Community Benefit Spending

Johnson, Emily K., MS; Hardy, Rose, MPH; Santos, Tatiane, MPH; Leider, Jonathon P., PhD; Lindrooth, Richard C., PhD; Tung, Gregory J., PhD, MPH

Journal of Public Health Management and Practice: July/August 2019 - Volume 25 - Issue 4 - p E9–E17
doi: 10.1097/PHH.0000000000000885
Research Reports: Research Full Report

Objective: To determine the association of state laws on nonprofit hospital community benefit spending.

Design: We used multivariate models to estimate the association between different types of state-level community benefit laws and nonprofit hospital community benefit spending from tax filings.

Setting: All 50 US states.

Participants: A total of 2421 nonprofit short-term acute care hospital organizations that filled an internal revenue service Form 990 and Schedule H for calendar during years 2009-2015.

Results: Between 2009 and 2015, short-term acute care hospitals spent an average of $46 billion per year in total, or $20 million per hospital on community benefit activities. Exposure to a state-level community benefit law of any type was associated with an $8.42 (95% confidence interval: 1.20-15.64) per $1000 of total operating expense greater community benefit spending. Spending amounts and patterns varied on the basis of the type of community benefit law and hospital urbanicity.

Conclusions: State laws are associated with nonprofit hospital community benefit spending. Policy makers can use community benefit laws to increase nonprofit hospital engagement with public health.

Colorado Health Institute, Denver, Colorado (Ms Johnson); Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anchutz, Aurora, Colorado (Mss Hardy and Santos and Drs Lindrooth and Tung); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider).

Correspondence: Gregory J. Tung, PhD, MPH, Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anchutz Medical Campus, 13001 E 17th Place, Mail Stop B119, Aurora CO 80045 (

Our research protocol was reviewed by the Colorado Multiple Institutional Review Board and determined to be not human subject research (COMIRB Protocol 15-0034).

This work was funded by a grant from the Agency for Healthcare Research and Quality (grant nos. R01 HS024959).

The authors declare no conflicts of interest.

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