Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement.
AndermannA. (2018). Screening for social determinants of health in clinical care: Moving from the margins to the mainstream. Public Health Reviews, 39(1), 1–17.
BegunJ. W.KahnL. M.CunninghamB. A.MalcolmJ. K.PotthoffS. (2018). A measure of the potential impact of hospital community health activities on population health and equity. Journal of Public Health Management and Practice, 24(5), 417–423. https://doi.org/10.1097/PHH.0000000000000617
5.
BlumenthalD.CollinsS. R.FowlerE. J. (2020). The affordable care act at 10 years—Its coverage and access provisions. The New England Journal of Medicine, 382(10), 963–969. https://doi.org/10.1056/NEJMhpr1916091
6.
CorriganJ.FisherE.HeiserS. (2015). Hospital community benefit programs: Increasing benefits to communities. Journal of the American Medical Association, 313(12), 1211–1212. https://doi.org/10.1001/jama.2015.0609
7.
Dankwa-MullanI.RheeK. B.WilliamsK.SanchezI.SyF. S.StinsonN.Jr.RuffinJ. (2010). The science of eliminating health disparities: Summary and analysis of the NIH summit recommendations. American Journal of Public Health, 100(S1), S12–S18.
8.
DrussB. G.MauerB. J. (2010). Health care reform and care at the behavioral health—Primary care interface. Psychiatric Services, 61(11), 1087–1092.
9.
FranzB.CroninC. E.SinghS. (2021). Are nonprofit hospitals addressing the most critical community health needs that they identify in their community health needs assessments?Journal of Public Health Management and Practice, 27(1), 80–87. https://doi.org/10.1097/PHH.0000000000001034
10.
FrenkJ. (2009). Reinventing primary health care: The need for systems integration. The Lancet, 374(9684), 170–173.
JamesJ. (2016). Nonprofit hospitals’ community benefit requirements. Policy Analysis Brief. H Series / Project Hope, Center for Health Affairs. Advance online publication. https://doi.org/10.1377/hpb20160225.954803
14.
LehmanB. J.DavidD. M.GruberJ. A. (2017). Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass, 11(8), e12328.
15.
LonginoC. F.MurphyJ. W.HendricksJ. (2020). The old age challenge to the biomedical model: Paradigm strain and health policy. Routledge.
16.
MarmotM.AllenJ. J. (2014). Social determinants of health equity. American Journal of Public Health, 104(Suppl. 4), S517–S519. https://doi.org/10.2105/AJPH.2014.302200
17.
MarmotM.FrielS.BellR.HouwelingT. A. J.TaylorS., & Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669. https://doi.org/10.1016/S0140-6736(08)61690-6
18.
MaysG. P.MamarilC. B.TimsinaL. R. (2016). Preventable death rates fell where communities expanded population health activities through multisector networks. Health Affairs, 35(11), 2005–2013.
19.
MillerB. F.PettersonS.BurkeB. T.PhillipsR. L.Jr.GreenL. A. (2014). Proximity of providers: Colocating behavioral health and primary care and the prospects for an integrated workforce. American Psychologist, 69(4), 443–451.
20.
Mulvaney-DayN.MarshallT.Downey PiscopoK.KorsenN.LynchS.KarnellL. H.MoranG. E.DanielsA. S.GhoseS. S. (2018). Screening for behavioral health conditions in primary care settings: A systematic review of the literature. Journal of General Internal Medicine, 33(3), 335–346.
21.
NohE.BegunJ. W.WhiteK. M.PotthoffS. J. (2022). US hospital engagement in cross-sector partnerships for population health improvement in socioeconomically distressed counties. Public Health, 205, 55–57.
22.
OldenP. C. (2003). Why hospitals offer health promotion: Perspectives for collaborating with health promotion practitioners. Health Promotion Practice, 4(1), 51–55. https://doi.org/10.1177/1524839902238291
23.
OldenP. C.HoffmanK. E. (2011). Hospitals’ health promotion services in their communities. Health Care Management Review, 36(2), 104–113. https://doi.org/10.1097/HMR.0b013e3181fb0f2b
24.
PennelC. L.McLeroyK. R.BurdineJ. N.Matarrita-CascanteD.WangJ. (2016). Community health needs assessment: Potential for population health improvement. Population Health Management, 19(3), 178–186. https://doi.org/10.1089/pop.2015.0075
25.
RosenbaumS.KindigD. A.BaoJ.ByrnesM. K.O’LaughlinC. (2015). The value of the nonprofit hospital tax exemption was $24.6 Billion in 2011. Health Affairs, 34(7), 1225–1233. https://doi.org/10.1377/hlthaff.2014.1424
26.
RozierM. D. (2020). Nonprofit hospital community benefit in the U.S.: A scoping review from 2010 to 2019. Frontiers in Public Health, 8, 72. https://doi.org/10.3389/fpubh.2020.00072
27.
RozierM. D.SinghS. R.JacobsonP. D.ProsserL. A. (2018). Priorities for investing in community health improvement: A comparison of decision makers in public health, nonprofit hospitals, and community nonprofits. Journal of Public Health Management and Practice, 25(4), 322–331. https://doi.org/10.1097/PHH.0000000000000848
28.
SinghS. R.CramerG. R.YoungG. J. (2018). The magnitude of a community’s health needs and nonprofit hospitals’ progress in meeting those needs: Are we faced with a paradox?Public Health Reports, 133(1), 75–84. https://doi.org/10.1177/0033354917739581
29.
SinghS. R.CroninC. E.ConleyC.LenhartM.FranzB. (in press). Equity as a guiding theme in nonprofit hospitals’ community health needs assessments and alignment between needs and strategies. American Journal of Preventive Medicine. Advance online publication. https://doi.org/10.1016/j.amepre.2022.07.013.
30.
SinghS. R.CroninC. E.YeagerV.BurnsA.FranzB. (2022). The role of local health departments in strengthening the alignment between nonprofit hospitals’ community health needs assessments and their implementation strategies. Journal of Public Health Management and Practice, 28(5), E764–E767.
31.
SinghS. R.YoungG. J.LeeS. Y. D.SongP. H.AlexanderJ. A. (2015). Analysis of hospital community benefit expenditures’ alignment with community health needs: Evidence from a national investigation of tax-exempt hospitals. American Journal of Public Health, 105(5), 914–921. https://doi.org/10.2105/AJPH.2014.302436
32.
StarrP. (2017). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. Hachette UK.
University of Wisconsin Population Health Institute. (2022). How healthy is your county?. County Health Rankings & Roadmaps. https://www.countyhealthrankings.org/
35.
WadeD. T.HalliganP. W. (2004). Do biomedical models of illness make for good healthcare systems?British Medical Journal, 329(7479), 1398–1401.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
