Non-Profit Hospitals and Community Health: Hospital Strategy Under the Affordable Care Act's Enhanced Community Benefit Regulations

Abstract

To better address the root causes of poor population health, US policymakers have advanced a range of policies meant to encourage greater cooperation between hospitals and local stakeholder organizations, centered around improving population health through investments addressing “upstream” determinants of health. This dissertation utilizes public reporting associated with one such policy – expanded community benefit regulations for nonprofit hospitals that require them to periodically assess the health of their communities and then develop a plan for addressing key health issues – to examine how hospitals’ investments in their community’s health and their relationships with other organizations have assembled since 2010. Content analysis was used to compile information from a sample of reports issued by hospitals to develop a rich database of hospital strategy characteristics. The resulting data was first used to group the networks formed between nonprofit hospitals and stakeholder organizations in response to the requirement to assess community health. The second component of this dissertation utilized a community orientation framework to measure different aspects of the investments made by hospitals to address prioritized local health issues. After analyzing the underlying structure of these different aspects using confirmatory factor analysis, the resulting factor scores were then used to develop a composite measure of hospital community orientation. This composite measure was then analyzed in conjunction with the first component of the dissertation to determine if highly integrated, diverse, and decentralized networks address community health issues differently relative to other hospital-based networks. The implications of the findings, particularly as it pertains to policy, are then discussed.