The Evolution of Community Benefit: Perspective on Progress Toward Purpose.

Area of Science:

• Health Policy
• Public Health
• Non-profit Management

Background:

• Non-profit hospitals in the USA must provide community benefit (CB) comparable to tax liabilities to maintain federal tax exemption.
• Since 2008, the IRS requires non-profit hospitals to file Form 990 Schedule H to document CB activities.

Purpose of the Study:

• To provide an overview of the historical evolution of hospital community engagement.
• To examine the policy evolution of community benefit requirements enforced by the IRS.

Main Methods:

• Literature review and policy analysis of IRS regulations and hospital reporting requirements.
• Examination of the conceptual underpinnings and measurement challenges of community benefit.

Main Results:

• The IRS has not explicitly stated the assumptions behind its community benefit policy, leading to sparse evidence on its impact on community health.
• Non-profit hospitals annually spend millions on CB activities and reporting, but the direct link to community health outcomes is unclear.
• Increased collaboration, while beneficial, adds complexity to measuring individual hospital or program contributions.

Conclusions:

• Conceptual frameworks like logic models or Collective Impact models could clarify assumed relationships between CB activities and health outcomes.
• Non-profit hospitals should establish their own targets, metrics, and evaluations to ensure cost-effectiveness of CB programs while complying with IRS mandates.
• Explicitly defining assumptions and measurable goals is crucial for demonstrating the impact of community benefit initiatives on community health and well-being.