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Background <p>One objective of hospital community benefit spending is to enhance community health, especially for vulnerable groups. Nonprofit hospitals have the potential to make a significant impact in addressing the social needs of communities through the strategic alignment of their community benefit initiatives with the specific needs of the community they serve. This alignment, however, does not always occur.</p> Objective <p>To compare the level of hospital spending with community social need. The hypothesis is that hospitals located in areas with greater social needs will allocate more resources to community needs.</p> Methods <p>Data from IRS Form 990 Schedule H and the American Hospital Association’s Annual Survey for 2011–2021 (2182 per year) were analyzed to evaluate hospital community benefit spending. Community benefits were defined as the combination of charity care (CHR), unreimbursed other means-tested (UOM), community benefit services (CBS), health services (not means-tested)/subsidized health services (SHS), community benefit contributions (CBC), and community building activities (CBA). The analysis used the CDC Social Vulnerability Index (SVI) to measure county-level social vulnerability and compared it to community benefit spending using random effect regression models to determine whether greater hospital spending on community benefits was positively associated with the social needs of the hospital’s community.</p> Results <p>Hospitals spend an average of 4.4% of their expenses on these six types of community benefits (IQR25, 1.5%; IQR50, 3.0%; IQR75, 5.4%). The two important predictors of increased spending on community-involved community benefits were the socioeconomic status and the percentage of racially minoritized populations.</p> Conclusions <p>Hospitals located in areas with high social vulnerability (SVI &gt;  0.65) spent almost twice as much on community benefits as hospitals located in areas with a low SV (SVI ≤ 0.65). The IRS and CMS should consider revising their monitoring to make sure that hospitals are focusing on the services that most benefit their community.</p>

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Examining the Relationship Between Hospital Community Benefits and Community Social Vulnerability

  • 期刊论文

  • 发表日期：

    2025年11月20日

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  • Hossein Zare,
  • Darrell J. Gaskin,
  • Danielle Bargo,
  • Irene Afua Quarshie,
  • Lauren Jordan Barrow,
  • Gerard Anderson

摘要

Background

One objective of hospital community benefit spending is to enhance community health, especially for vulnerable groups. Nonprofit hospitals have the potential to make a significant impact in addressing the social needs of communities through the strategic alignment of their community benefit initiatives with the specific needs of the community they serve. This alignment, however, does not always occur.

Objective

To compare the level of hospital spending with community social need. The hypothesis is that hospitals located in areas with greater social needs will allocate more resources to community needs.

Methods

Data from IRS Form 990 Schedule H and the American Hospital Association’s Annual Survey for 2011–2021 (2182 per year) were analyzed to evaluate hospital community benefit spending. Community benefits were defined as the combination of charity care (CHR), unreimbursed other means-tested (UOM), community benefit services (CBS), health services (not means-tested)/subsidized health services (SHS), community benefit contributions (CBC), and community building activities (CBA). The analysis used the CDC Social Vulnerability Index (SVI) to measure county-level social vulnerability and compared it to community benefit spending using random effect regression models to determine whether greater hospital spending on community benefits was positively associated with the social needs of the hospital’s community.

Results

Hospitals spend an average of 4.4% of their expenses on these six types of community benefits (IQR25, 1.5%; IQR50, 3.0%; IQR75, 5.4%). The two important predictors of increased spending on community-involved community benefits were the socioeconomic status and the percentage of racially minoritized populations.

Conclusions

Hospitals located in areas with high social vulnerability (SVI >  0.65) spent almost twice as much on community benefits as hospitals located in areas with a low SV (SVI ≤ 0.65). The IRS and CMS should consider revising their monitoring to make sure that hospitals are focusing on the services that most benefit their community.