Date of Award

4-2022

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Kieran Fogarty, Ph.D.

Second Advisor

Rob Lyerla, Ph.D.

Third Advisor

David Wingard, Ph.D.

Fourth Advisor

Ron Cisler, Ph.D.

Keywords

community benefit, community health, health improvement, health outcomes, implementation plan, needs assessment

Abstract

The Internal Revenue Service's (IRS) hospital community benefit standard aims to improve the community's health, it is a test the IRS uses to determine whether a hospital is organized and operated for the charitable purpose of promoting health. Participation in this program is required of all not-for-profit hospitals in the US, who spend billions of dollars annually in community benefit in place of taxes. Hospitals must annually submit IRS form 990 Schedule H and are required to report costs associated with their provision of community benefit spending. In addition, a hospital must conduct community health needs assessment (CHNA) and implementation plan (IP) every three years; list their health improvement activities and spending under the community health improvement category on the Schedule H IRS form.

With annual spending of billions of dollars and minimal research, this is an opportunity to research whether these dollars are doing what the original law intended - to impact the community's health. To determine impact, County Health Rankings & Roadmaps (CHR&R) measures nearly every county's health in all 50 states and produces annual health outcomes and health factors scores. This dissertation aims to analyze the relationship between hospital community benefit spending and CHR&R scores, whether there is any difference between hospitals in Medicaid expansion states and non-expansion states in community benefit spending and explore a single hospital in a health award-winning community CHNA and IP.

The study sample is rural, general acute care, not-for-profit hospitals in the US from a matched peer county group using the CHR&R county peer group 59.

This study identified a weak, negative relationship between hospital community benefit spending and the CHR&R Outcomes scores (r=-.29, N=240) and a weak, positive relationship between hospital community health improvement spending and CHR&R Outcomes scores (r=.15, N=240). There is a weak, positive relationship between hospital community health improvement spending and CHR&R Factor scores (r=.29, N=240). Six counties at the individual county level had statistically significant findings between community benefit spending and CHR&R scores.

This study identified a weak, negative relationship between hospital community benefit spending and the CHR&R Outcomes scores (r=-.29, N=240) and a weak, positive relationship between hospital community health improvement spending and CHR&R Outcomes scores (r=.15, N=240). There is a weak, positive relationship between hospital community health improvement spending and CHR&R Factor scores (r=.29, N=240). Six counties at the individual county level had statistically significant findings between community benefit spending and CHR&R scores.

And lastly, in the Robert Wood Johnson Culture of Health award-winning community of Salinas, California, the sample hospital Salinas Valley Memorial Health System's CHNA and IP did meet the minimum IRS requirements. Still, they fell short of the best practices for community change found in the literature. The IP listed sources and was evidence-based; however, it was programmatic, not creating change at the system, policy, or environment level.

Access Setting

Dissertation-Open Access

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