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Examining the Relationship Between Hospital Community Benefits and Community Social Vulnerability.

Hossein Zare1, Darrell J Gaskin2, Danielle Bargo2

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Hospitals in high-need areas spend more on community benefits, particularly those with lower socioeconomic status and more racial minorities. This suggests a positive correlation between social vulnerability and hospital community benefit allocation.

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Area of Science:

  • Public Health
  • Health Services Research
  • Health Economics

Background:

  • Nonprofit hospitals aim to improve community health, especially for vulnerable populations.
  • Strategic alignment of hospital community benefit initiatives with community needs is crucial but not always achieved.
  • Understanding spending patterns is key to maximizing impact.

Purpose of the Study:

  • To compare hospital community benefit spending with community social needs.
  • To test the hypothesis that hospitals in areas with greater social needs allocate more resources.
  • To identify factors influencing community benefit allocation.

Main Methods:

  • Analysis of IRS Form 990 Schedule H and AHA Annual Survey data (2011-2021).
  • Defined community benefits including charity care, unreimbursed means-tested care, and community building activities.
  • Used CDC Social Vulnerability Index (SVI) to measure county-level social needs and employed regression models to assess associations with hospital spending.

Main Results:

  • Hospitals spend an average of 4.4% of expenses on community benefits.
  • Socioeconomic status and percentage of racially minoritized populations predicted increased spending.
  • Hospitals in high SVI areas (SVI > 0.65) spent nearly twice as much as those in low SVI areas (SVI ≤ 0.65).

Conclusions:

  • Hospital community benefit spending is associated with community social needs.
  • Hospitals in socially vulnerable areas allocate significantly more resources to community benefits.
  • Recommendations for IRS and CMS to revise monitoring to ensure focus on community-benefiting services.