Dissertation/Thesis Abstract

Assessing Convergence of Community Benefit Programs and Community Health Needs among North Carolina's Tax-Exempt Hospitals
by Fos, Elmer B., Ph.D., The University of North Carolina at Charlotte, 2018, 137; 10838721
Abstract (Summary)

The Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every three years, formulate implementation strategies, and report yearly to the IRS and the public the progress of their work. The IRS CHNA incentivizes hospitals to provide programs responsive to community health needs. The purpose of this study was to examine the relationship between community benefit programs and prioritized community health needs in the context of a national IRS reporting requirement through analysis of published community benefit reports among North Carolina’s (NC) tax-exempt hospitals.

This study employed quantitative research that analyzed longitudinal and cross-sectional data; qualitative research that reviewed published documents; and mixed-methods research that analyzed the integrated quantitative and qualitative results. The findings indicate that performing IRS-mandated CHNA did not substantially increase the alignment of community benefit programs with prioritized community health needs but did clearly highlight those needs. NC tax-exempt hospitals continue to focus on providing patient care financial assistance than population health, a strategy misaligned with community health needs. Although the hospitals are beginning to address population health and access to care concerns, their dollar expenditures in these areas paled in comparison to patient care financial assistance. If the IRS’ purpose in mandating CHNA was to spur a shift in community benefit priorities toward population health needs and away from the traditional patient care financial assistance, then, the evidence from 4 years after the requirement’s implementation, indicates it is currently failing in North Carolina. As elucidated in the articles, their ingrained patient-level intervention perspective and desire to recover high unreimbursed costs or lost revenues for providing care to Medicare, Medicaid, and poor patients likely influence the hospitals’ community benefit programming to favor individual welfare over population health. Nevertheless, policymakers should continue to direct community benefit programs toward population health because it is a step in the right direction. Organizational change takes time and the desired results of policy interventions are usually incremental. Thus, conducting CHNA must remain a legal obligation by non-profit hospitals for maintaining their privileged tax status to facilitate organizational paradigm shift in community benefit programming toward population health programs or community building activities and away from individual welfare.

Indexing (document details)
Advisor: Elnitsky, Christine A., Thompson, Michael E.
Commitee: Carman, Joanne G., Platonova, Elena A., Troyer, Jennifer L.
School: The University of North Carolina at Charlotte
Department: Health Services Research
School Location: United States -- North Carolina
Source: DAI-B 79/12(E), Dissertation Abstracts International
Subjects: Public health, Public policy, Health care management
Keywords: Community benefit, Community health, Community health needs assessments, Population health, Tax-exempt hospitals
Publication Number: 10838721
ISBN: 978-0-438-17268-5
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