Strengthening Community Benefit Regulations to Address Health Equity
Hospitals have a responsibility to address longstanding health inequities in the communities they serve. One way they can do this is through their community benefit activities. Under federal law, nonprofit hospitals are required to provide community benefits in order to maintain their tax-exempt status. To help guide their investments, they must conduct a community health needs assessment every three years and develop an implementation strategy that responds to identified needs. However, there is little regulation on the extent to which community members must be involved in this process. Furthermore, while hospitals may identify health disparities in their communities, surprisingly few devote resources to address them.
States have the opportunity to go beyond what is required at the federal level and strengthen their community benefit regulations to ensure that hospitals meaningfully engage their communities and address health inequities. The National Academy for State Health Policy (NASHP) recently published a blog post describing how some states are encouraging hospitals to pivot community benefit investments toward equity goals, particularly in light of disparities in COVID-19 outcomes.
In order to leverage community benefit to advance health equity, states can implement regulations that require hospitals to:
Ensure meaningful community engagement with historically excluded populations in needs assessments and implementation strategies.
Federal regulations require community involvement in hospitals’ needs assessments, but allow a fairly surface-level approach to involving community members. The regulations state that nonprofit hospitals must “solicit and take into account input received from persons who represent the broad interests of that community”.
At the Center, we believe that meaningful community engagement is more than just receiving input from community members. States have the opportunity to strengthen engagement in this process by requiring hospitals to conduct needs assessments in consultation with community members, including historically excluded populations. Community members should be given decision-making roles in the process of identifying needs and priorities and should also be involved as the hospital develops its implementation strategy.
The Center’s Change Package on person-centered engagement highlights strategies for achieving this level of engagement in health care systems, and our Consumer and Community Engagement Tip Sheet provides additional guidance on maintaining engagement during COVID-19.
Identify health inequities and implement activities to explicitly advance health equity.
When conducting their needs assessments, hospitals should examine closely the presence of health inequities in their communities. Although this is not federally required, many hospitals and states are recognizing the importance of incorporating measures of health equity in their needs assessments. For example, Maryland has enacted legislation that requires hospitals’ needs assessments to describe their efforts to track and reduce health disparities in the community.
Though states and hospitals are increasingly identifying health inequities, very few are actually implementing strategies to address and reduce these inequities. A study on nonprofit urban hospitals found that 65 percent of hospitals in the study included at least one explicit health equity term in their needs assessment, but just nine percent included an explicit activity to promote health equity in their implementation strategy. In addition to state regulations to include such activities, ensuring that community members are meaningfully engaged in developing the implementation strategy can help keep health equity a priority in community benefit investments.