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Hospitals’ Benefit to the Community: Research, Policy and Evaluation

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Federal requirement for non-profit hospitals to document how they benefit their communities, as well as increasing recognition of the importance of the social determinants of health, have resulted in new health promotion and health education activities, greater attention to community health needs assessments, ...

Federal requirement for non-profit hospitals to document how they benefit their communities, as well as increasing recognition of the importance of the social determinants of health, have resulted in new health promotion and health education activities, greater attention to community health needs assessments, and more collaboration among health and social service organizations serving a community. The purpose of this research topic is to disseminate research, policy and evaluation studies pertaining to hospitals’ provision of formal “community benefit” as required by the Internal Revenue Service (IRS), as well as the broader perspective of hospital efforts—including those of non-profit, for-profit, and government organizations—to improve the health of their communities.

Non-profit hospitals in the USA have been required by the Internal Revenue Service (IRS) to report detailed information about their community benefit activities since 2007. In 2009, an Academy Health pre-conference, entitled “Community Benefit: The Research Agenda for the First Five Years” was convened to discuss the current state of non-profit hospitals’ community benefit activities and develop a research agenda for the upcoming five years. The Proceedings of the conference laid out critical issues that should be examined as non-profit hospitals began to report their community benefit activities to the IRS as part of their annual tax return (IRS Form 990, specifically Schedule H). In 2010, the Patient Protection and Affordable Care Act (ACA) laid out further requirements for non-profit hospitals to maintain their tax-exempt status. Among these is the conduct of a community health needs assessment every three years and the development of a community health improvement plan to address identified needs.

Now, ten years after this inaugural conference, detailed data on the community benefit activities of over 2,000 non-profit hospitals and health systems are available to policymakers, researchers, and the public at large. Community Health Needs Assessments have become widespread and involve many organizations in addition to hospitals. What do all these data and reports tell us? Have the original research questions been examined? What additional information has been gathered to inform community benefit as a policy? Beyond research, dozens of programs have been created by non-profit hospitals under the auspice of Community Benefit and other types of hospitals to demonstrate their commitment to their communities. What has been accomplished? Evaluations are being done on a wide variety of interventions, including health promotion and education programs. What do they tell about the structure, goals, and outcomes of community benefit activities?

We invite all Article Types, including original research, evaluation, perspective, community case studies, policy analyses, and reviews, as well as any other for which the subject matter is related to community benefit. We would particularly like to encourage those who have analyzed the data made available through IRS Form 990 Schedule H to submit their work. Possible topics include: hospital application of financial aid policies; trends in uncompensated care, especially with changes that resulted from the ACA and challenges to its implementation; hospital initiatives related to social determinants of health; definitions of “community”; the relationship of community health improvement plans to community needs assessments; collaboration among community agencies; the hospital’s role as anchor or backbone institution in their community; hospital community benefit spending compared to a hospital’s financial parameters; state policy variations in community benefit requirement; analyses of thresholds for financial contributions to the community.

Evaluation studies are invited on topics such as the impact of an intervention on the health status of a community; the results of health promotion programs; the appropriate metrics for measuring Collective Impact; a comparison of secondary data versus primary data for community health needs assessments; the relationship of interventions aimed at social determinants of health compared to interventions aimed at individual health promotion/disease prevention.

Policy analyses are invited to address the salient issue of the cost for a hospital to complete Form 990 Schedule H versus the impact of its contribution on the community; a comparison of the community-oriented activities of for-profit and non-profit hospitals; and the cost and rewards accrued from implementing penalties for failure to comply with federal or state community benefit regulations; an updated contrast of federal and state community benefit regulations. Case studies with “lessons learned” and Perspective (Opinion) types of articles may also be submitted. Although the majority of articles are expected to focus on activities in the USA, international examples of hospital engagement with the community are also welcome.

Manuscripts are due October 31, 2019. Abstracts are requested by May 31, 2019. Each paper will be peer-reviewed and published as accepted. A total of ten papers or more will be compiled into an ebook, expected in 2020.


Keywords: Hospital Community Benefit, Non-Profit Hospitals, Hospital Community Outreach, IRS Form 990 Schedule H, Health Systems and the Community, Community Health Needs Assessment, Community Health Improvement Plan


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