State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits

Author:

Singh Simone R.1,Young Gary J.,Loomer Lacey,Madison Kristin

Affiliation:

1. Northeastern University

Abstract

Abstract Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009–11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals.

Publisher

Duke University Press

Subject

Health Policy

Reference17 articles.

1. American Hospital Association. 2014. “Fast Facts on US Hospitals.” www.aha.org/research/rc/stat-studies/fast-facts.shtml (accessed June 1, 2016).

2. Bunce Victoria Craig , and WieskeJ. P.2009. “Health Insurance Mandates in the States 2009.” www2.cbia.com/ieb/ag/CostOfCare/RisingCosts/CAHI_HealthInsuranceMandates2009.pdf (accessed June 17, 2016).

3. Dranove David , GarthwaiteCraig, and OdyChristopher A.2015. “A Floor-and-Trade Proposal to Improve the Delivery of Charity-Care Services by U.S. Nonprofit Hospitals.” Hamilton Project, October. www.hamiltonproject.org/assets/files/floor_and_trade_improve_delivery_of_charity_care_services_dranove.pdf.

4. IRS Rules Will Not Stop Unfair Hospital Billing and Collection Practices;Fuse Brown;American Medical Association Journal of Ethics,2015

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