Provide Benefits To Community Research Articles

Community Benefit and Tax-Exemption Levels at Non-Profit Hospitals Across U.S. States.

To assess the association between state policies and sociodemographic characteristics and state mean fair share spending at non-profit hospitals. Fair share spending is a hospital's charity care and community investment less the estimated value of their tax-exempt status. Hospitals with non-profit status in the United States are exempt from paying taxes. In return, they are expected to provide community benefits by subsidizing medical care for those who cannot pay and investing in the health and social needs of their community. We used a multivariable linear regression model to determine the association of state-level sociodemographics and policies with state-level mean fair share spending in 2019. Fair share spending data was obtained from the Lown Institute. We found no association between the percentage of people living in poverty, in rural areas, or U.S. region and fair share spending. Similarly, there was no association found for state minimum community benefit and reporting requirements. The state percentage of racial/ethnic minorities was associated with higher mean fair share spending [+$1.48 million for every 10% increase (95% CI: 0.01 to 2.96 million)]. Medicaid expansion status was associated with a 6.9-million-dollar decrease (95% CI: -10.4 to -3.3 million). State-level community benefit policies have been ineffective at raising community benefit spending to levels comparable to the value of non-profit hospital tax-exempt status.

Traditional and GenAI Text Analysis of COVID-19 Pandemic Trends in Hospital Community Benefits IRS Documentation

The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to the U.S. healthcare system, particularly for nonprofit U.S. hospitals that are obligated to provide community benefits in exchange for federal tax exemptions. We sought to examine how hospitals initiated, modified, or disbanded community benefits programming in response to the COVID-19 pandemic. We used the free-response text in Part IV of Internal Revenue Service (IRS) Form 990 Schedule H (F990H) to assess health equity and disparities. We combined traditional key term frequency and Hierarchical Density-Based Spatial Clustering of Applications with Noise (HDBSCAN) clustering approaches with a novel Generative Pre-trained Transformer (GPT) 3.5 summarization approach. Our research reveals shifts in community benefits programming. We observed an increase in COVID-related terms starting in the 2019 tax year, indicating a pivot in community focus and efforts toward pandemic-related activities such as telehealth services and COVID-19 testing and prevention. The clustering analysis identified themes related to COVID-19 and community benefits. Generative Artificial Intelligence (GenAI) summarization with GPT3.5 contextualized these changes, revealing examples of healthcare system adaptations and program cancellations. However, GPT3.5 also encountered some accuracy and validation challenges. This multifaceted text analysis underscores the adaptability of hospitals in maintaining community health support during crises and suggests the potential of advanced AI tools in evaluating large-scale qualitative data for policy and public health research.

Understanding the Intersection of Waqf and Pesantren Culture: A Study on Local Wisdom

Waqf, as an integral component of the Islamic philanthropic development model, Waqf plays a crucial role in enhancing educational quality. Its economic potential is further amplified through inter-governmental partnerships. This paper aims to elaborates on the potential of waqf as an economic instrument. Utilizing qualitative literature review methods, this article underscores the economic potential of waqf in addressing a range of pertinent issues. The findings of the study reveal that (1) waqf management aligns with economic capabilities; (2) economic management is in accordance with the practices of Prophet Muhammad and his companions; (3) management models are diversifying as an adaptive response to modern economic theory; (4) Waqf holds potential for economic development. Furthermore, this study's outcomes align with the waqf management concept implemented in several countries, demonstrating its success in managing waqf and providing community benefits, all grounded in Islamic teachings.

Driving nonprofit hospitals to address health equity in community

ABSTRACT While non-profit hospitals strive to promote health equity through the provision of community benefits, there is limited research on the factors that influence the allocation of this spending. Using IRS Form 990, American Community Survey, and Medicare data sets with hierarchical linear modelling, this study incorporates the demand and supply perspectives into research on non-profit hospitals’ community benefit spending. We provided a more nuanced understanding of how each perspective is connected to spending on welfare and non-welfare services, respectively. This study provides new evidence of the role of non-profit hospitals in advancing health equity.

Influence of Not-for-Profit Hospital Ownership Type on Community Benefit and Charity Care.

Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research.Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals.

Community Engagement in Nonprofit Hospital Community Health Needs Assessments and Implementation Plans.

Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments. The objective of this study was to explore community engagement and representation in CHNAs and IPs. The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021. For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified. Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies. Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

Characteristics of US hospitals using extraordinary collections actions against patients for unpaid medical bills: a cross-sectional study

ObjectiveThis study aims to characterise and evaluate the largest 100 hospitals in the USA that have adopted aggressive collection tactics to pursue patients with unpaid medical bills, such as lawsuits,...

A Comparison of Nonprofit Hospital Charity Care Policies and Community Benefit in Central Ohio to Peer Cities

Background: Nonprofit hospitals in the United States are required to provide community benefits, including charity care, to receive tax exemption from the federal government. Central Ohio's nonprofit hospitals have agreed to the same charity care policies, which may be unique compared to other communities across the county. The aim of this research is to compare the charity care policies of hospitals in Columbus, Ohio, to their peer cities, investigating if hospitals in similar cities have common shared charity care thresholds and to determine if hospitals in peer cities provided similar levels of community benefit. Methods: Tax data from nonprofit hospitals in 21 cities were collected and analyzed using Microsoft Excel (Microsoft Corporation). City community benefit data was summed and averaged using Excel to create a graphical representation of the data. Results: Only Columbus, Ohio, and Providence, Rhode Island, reported the same charity care thresholds across hospitals. Data demonstrate that Columbus provides less community benefit in dollars to total expenses compared to peer cities; however, this appears to be only true regarding other community benefit excluding charity care. Columbus was near the median among cities examined in regard to percentage of charity care to total community benefit. Conclusion: Results suggest variability in the amount and type of community benefit nonprofit hospitals provide. Central Ohio hospitals have the same charity care thresholds and spent approximately the same in total community benefit however it is not transparent how these funds are utilized. Current federal regulations do not assess whether the community benefits reported are affecting community health outcomes.

Black Lives Matter: Moving from passion to action in academic medical institutions

The year 2020 opened the eyes of many to the structures of racism that persist in our country. As the visceral urgency of those galvanizing moments fade, organizations must move beyond releasing supportive statements and determining how they can live up to their stated values. To truly support Black lives, academic medical centers (AMCs) must commit to critically examine and improve the manner in which daily practices, culture, and context uplift Black students, health care professionals, and patients to achieve health equity. One step is to create a culture that is willing to listen and improve when people express discomfort or report mistreatment in order to retain people who are underrepresented in medicine (URiM) in a welcoming environment. Academic centers should address microaggressions to create a safe work and learning atmosphere. Then, ensure that faculty, trainees, and staff represent the demographics of the communities in which institutions are situated. Recruiting and retaining an inclusive health care workforce must be systematic and intentional to achieve representation. Studies have shown that racial and ethnic concordance between providers and patients improves patient satisfaction and health outcomes. Further, business studies have shown that racially diverse leadership teams outperform teams that are more homogenous. Diversity benefits colleagues, learners, and patients by considering different perspectives and improving problem solving. Additionally, AMCss should teach about structural racism as a social determinant of health to raise awareness of a common cause of health disparities and understand why patients of color may distrust the medical system. Furthermore, academic centers should work with local leaders to assess needs and provide community benefits and advocate for policies that meet those needs. While there are some challenges in starting these conversations in our institutions, changing the status quo is necessary to achieve health equity for all.

Strategic reporting by nonprofit hospitals: an examination of bad debt and charity care

In this paper, we examine bad debt and charity care reporting by nonprofit hospitals around bond issuance. Given the tax advantages afforded to nonprofit hospitals, including the ability to issue tax-exempt debt, hospital managers encounter stakeholder pressure to provide community benefits. When nonprofits issue debt, they also face economic pressure to meet creditors’ financial performance expectations. We document a reporting strategy that allows nonprofit hospitals to reduce the cost of bond debt while simultaneously alleviating regulators’ and community members’ concerns about inadequate provision of charity care. Using data from public bond issues for California nonprofit hospitals, we find that hospital managers shift costs from bad debt expense to charity care in periods prior to a public bond issuance and that the strategy is associated with a lower cost of debt. Our results inform those relying on accounting measurements to infer nonprofit hospitals’ social good provisions and financial health.

Sport for a Livelihood and Well-being: From Leisure Activity to Occupational Devotion

This study explored the occupational devotion of lifestyle entrepreneurs and their well-being. Although the number of enterprises in the sports industry increased over the past years, limited literature exists on this topic. Therefore, this paper focused on lifestyle entrepreneurs who turned their sports into their occupations. We conducted semi-structured interviews and a follow-up survey with lifestyle entrepreneurs (N = 13) from various sports (e.g., yoga, kiting, football). The thematic analysis revealed a strong connection between the individuals’ choice of career and well-being. Other themes (and sub-themes), such as mental and physical health and value (co-)creation, were identified, corroborating the authors’ assumption that these lifestyle entrepreneurs started a career in their sports to reach a higher quality of life. The results uncovered that well-being and occupational devotion are closely linked. Co-creation is connected to well-being, and this can accrue social capital in the community. Thus, the results recommended support for lifestyle entrepreneurs as they provide community benefits.

Nonprofit Hospital Community Benefits: Collaboration With Local Health Departments to Address the Drug Epidemic.

Nonprofit hospitals (NFPs) are required to provide community benefits, which have been historically focused on provision of medical care, to keep their tax exemption status. To increase hospital investment in community health, the Patient Protection and Affordable Care Act required NFPs to conduct community health needs assessments and address identified needs. Some states have leveraged this provision to encourage collaboration between NFPs and local health departments (LHDs) in local health planning. The objective of this study was to examine the association of NFP-LHD collaboration in local health planning targeting drug use, with drug-induced mortality. We conducted difference-in-differences analyses using drug-induced mortality data from 2009 to 2016, encompassing the first 3 years after NFP-LHD collaboration in local health planning specific to drug use. We evaluated drug-induced mortality in 22 counties in which collaboration was required in comparison with that in 198 control counties. We used data collected from implementation strategy reports by NFPs and combined it with data on hospital characteristics, as well as state-level and county-level factors associated with drug-induced mortality. The primary outcome was county-level drug-induced mortality per 100,000 population. Counties, in which NFP-LHD collaboration in local health planning was required and in which NFPs and LHDs jointly prioritized drug use, experienced a deceleration in drug-induced mortality of ~8 deaths per 100,000 population compared with the mortality rate they would have experienced without collaboration. Collaboration between NFPs and LHDs to address drug use was associated with a deceleration in drug-induced mortality. Policymakers can leverage community benefit regulation to encourage NFP-LHD collaboration in local health planning.

Does non-profit commercialization help reduce social inequality? Revisiting the cross-subsidization hypothesis

ABSTRACT The non-profit sector has a long history of serving vulnerable people and promoting social equity. The growing reliance on commercial income in the non-profit sector has aroused wide concern about mission drift and the loss of identity. The cross-subsidization hypothesis is often used to justify non-profit commercialization, but this hypothesis has not been subject to many empirical tests. This study examines how non-profit hospitals’ commercial income affects their provision of community benefits. The results indicate that hospitals with more commercial income provide less unprofitable programmes to serve disadvantaged groups and reduce health disparities.

An Alternative Source of Development for Local Governments: Local Literacy

Local literacy could be defined as a process of gaining skills for the recognition of local assets, historical sites, places and literary works, which are important for countries in a national and spiritual sense (historical, cultural, touristic, economic, etc.) in the areas where citizens live, being aware of the basic characteristics of the local habitat, and when necessary, reporting the gained knowledge and skills to other people through presentations appropriately prepared (Güven, 2019). This conceptual article discusses opinions and suggestions about the introduction of local literacy skills, which are considered very necessary and profitable for local governments, education and training institutions. It also discusses the contributions provided with the gain of local literacy skills to local governments. The article presents ways in which students can be supported to learn about and adopt the material and spiritual items with a certain value, the individuals and institutions that provide community benefits, sites, natural resources, and the richness around them. Local governments are also provided with some considerations and suggestions about local literacy, which is considered necessary for local governments, and their contributions to local governments as an incentive to invest.

Establishing a Community Air Monitoring Network in a Wildfire Smoke-Prone Rural Community: The Motivations, Experiences, Challenges, and Ideas of Clean Air Methow's Clean Air Ambassadors.

In response to wildfire-related air quality issues as well as those associated with winter wood stove use and prescribed and agricultural burning, Clean Air Methow’s Clean Air Ambassador program established a community air monitoring network (CAMN) to provide geospatially specific air quality information and supplement data generated by the two Washington State Department of Ecology nephelometers situated in the area. Clean Air Ambassadors (CAAs) were purposefully selected to host low-cost air sensors based on their geographic location and interest in air quality. All 18 CAAs were interviewed to understand their motivations for participation, experiences using the data, challenges encountered, and recommendations for future project directions. Interview transcripts were coded, and a qualitative analysis approach was used to identify the key themes in each domain. The reported motivations for participation as a CAA included reducing personal exposure, protecting sensitive populations, interest in air quality or environmental science, and providing community benefits. CAAs used CAMN data to understand air quality conditions, minimize personal or familial exposure, and engage other community members in air quality discussions. Opportunities for future project directions included use for monitoring other seasonal air quality issues, informing or reducing other pollution-generating activities, school and community educational activities, opportunities for use by and engagement of different stakeholder groups, and mobile-friendly access to CAMN information. Limited challenges associated with participation were reported. Additional research is necessary to understand the community-level impacts of the CAMN. The findings may be informative for other rural wildfire smoke-prone communities establishing similar CAMNs.

Strategic Reporting by Nonprofit Hospitals: An Examination of Bad Debt and Charity Care

In this paper, we examine bad debt and charity care reporting by nonprofit hospitals around bond issuance. Given the tax advantages afforded to nonprofit hospitals, including the ability to issue tax-exempt debt, hospital managers encounter stakeholder pressure to provide community benefits. When nonprofits issue debt, they also face economic pressure to meet creditors’ financial performance expectations. We document a reporting strategy that allows nonprofit hospitals to reduce the cost of bond debt while simultaneously alleviating regulators’ and community members’ concerns about inadequate provision of charity care. Using data from public bond issues for California nonprofit hospitals, we find that hospital managers shift costs from bad debt expense to charity care in periods prior to a public bond issuance and that the strategy is associated with a lower cost of debt. Our results inform those relying on accounting measurements to infer nonprofit hospitals’ social good provisions and financial health.

Advancing Public Health Through Tax-Exempt Hospitals: Nonprofits’ Revenue Streams and Provision of Collective Goods

Nonprofit organizations play an essential role in the provision of collective goods. Focusing on a unique subsector in the United States, this study examines the extent to which nonprofit hospitals’ provision of community benefits is related to their revenue streams. Building on existing theories, we postulate that as the proportion of a certain revenue source (i.e., government grants, private contributions, and program fees) increases, its corresponding benefits also increase. Using data from the Internal Revenue Service (IRS) 990 filed by tax-exempt hospitals nationwide, we performed panel data analysis with year and id fixed effects using robust standard errors. The findings show that the proportion of private donations is positively associated with community benefits, whereas that of program income is negatively related to community benefits. Overall, nonprofits’ decision to serve disadvantaged groups and larger communities is associated with their income sources. The study raises implications that are pertinent to nonprofit management, public administration, and health administration.

Health insurance and social capital in Ghana: a cluster randomised controlled trial

BackgroundThe National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003, enrolment is still far from the desired target of universal coverage. Low community engagement in the design and management of the system was identified as one of the main barriers. The aim of the current study was to explore the role of social capital in NHIS enrolment in two regions of Ghana, Western and Greater Accra.MethodsThe study involved a cluster-randomised controlled trial of 3246 clients of 64 healthcare facilities who completed both a baseline and a follow-up survey. Thirty-two facilities were randomly selected to receive two types of intervention. The remaining facilities served as control. The interventions were co-designed with stakeholders. Baseline and follow up surveys included measures of different types of social capital, as well as enrolment in the health insurance scheme.ResultsThe study found that the interventions encouraged NHIS enrolment (from 40.29 to 49.39% (intervention group) versus 36.49 to 36.75% (control group)). Secondly, certain types of social capital are associated with increased enrolment (log-odds ratios (p-values) of three types of vertical social capital are 0.127 (< 0.01), 0.0952 (< 0.1) and 0.15 (< 0.01)). Effectiveness of the interventions was found dependent on initial levels of social capital: respondents with lowest measured level of interpersonal trust in the intervention group were about 25% more likely to be insured than similar respondents in the control group. Among highly trusting respondents this difference was insignificant. There was however no evidence that the interventions effect social capital. Limitations of the study are discussed.ConclusionWe showed that the interventions helped to increase enrolment but that the positive effect was not realized by changes in social capital that we hypothesised based on result of the first phase of our study. Future research should aim to identify other community factors that are part of the enrolment process, whether other interventions to improve the quality of services could help to increase enrolment and, as a result, could provide community benefits in terms of social capital.Our findings can guide the NHIS in Ghana and other health organizations to enhance enrolment.Trial registrationEthical Clearance by Ghana Health Service Ethical Committee No. GHS-ERC 08.5.11.

Provisions for community participation in heritage management: case of the Zambezi Source National Monument, Zambia

ABSTRACTEffective community participation is a topical issue in protected areas and heritage management. Community participation initiatives are considered to have great capacity to enhance conservation and provide community benefits. However, many previous studies have indicated that in spite of the acclaimed potential, there are minimal levels of community participation in practice. Legislation, policy and institutional provisions can play an important role in enhancing community participation by serving as foundations upon which practices are built. This study aims to examine the provisions for community participation in heritage management at the Zambezi Source National Monument (ZSNM) in Zambia. The results based on content analysis of the key ZSNM-related documents show that there are no provisions for community participation in the Zambia Heritage Act. While the Zambia Heritage Policy and the ZSNM Management Plan have some provisions for community participation, they are largely not harmonised or consistent with each other. Furthermore, when compared with the conceptual framework adapted for this study, the majority of the provisions within the key ZSNM-related documents do not indicate intentions to facilitate effective community participation.

State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits.

Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009-11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals.