Skip to main content Accessibility help
×
Home
Hostname: page-component-5959bf8d4d-c2ftz Total loading time: 0.739 Render date: 2022-12-08T10:57:44.051Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

The Role of Community Health Needs Assessments in Medicalizing Poverty

Published online by Cambridge University Press:  01 January 2021

Abstract

The Patient Protection and Affordable Care Act (ACA), passed in 2010, is considered by many to be the most significant healthcare overhaul since the 1960s, but part of its promise — improvement of population health through requirements for non-profit hospitals to provide “community benefit” — has not been met. This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities.

Type
Symposium 1 Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Obama, B., “United States Health Care Reform: Progress to Date and Next Steps,” JAMA 316, no. 5 (2016): 525-532.CrossRefGoogle Scholar
Rosenbaum, S., “Additional Requirements for Charitable Hospitals: Final Rules on Community Health Needs Assessments and Financial Assistance,” Health Affairs Blog, January, 3, 2015, available at <https://www.healthaffairs.org/do/10.1377/hblog20150123.044073/full/> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Internal Revenue Service, Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return; Final Rule, 79 Fed. Reg. 78956, December 31, 2014.Google Scholar
Dixon, J., “Social Determinants of Health,” Health Promotion International 15, no. 1 (2000): 87-89.Google Scholar
Magnan, S., “Social Determinants of Health 101 for Health Care: Five Plus Five: National Academy of Medicine, October, 10, 2017, available at <https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Barnett, K., “Best Practices for Community Health Needs Assessment and Implementation Strategy Development: A Review of Scientific Methods, Current Practices, and Future Potential,” Public Health Institute, February 2012, available at <http://www.phi.org/uploads/application/files/dz9vh55o3bb2x56lcrzyel83fwfu3mvu24oqqvn5z6qaeiw2u4.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Davis, C., “Nonprofit Hospitals and Community Benefit,” National Health Law Program, (2011), available at <http://www.healthlaw.org/about/staff/corey-davis/all-publications/nonprofit-hospitals-and-community-benefitpdf#.WlUXjW-dOpqg> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
See Bharmal, N. et.al., “Understanding the Upstream Social Determinants of Health,” California: RAND, May 2015, available at <https://www.rand.org/pubs/working_papers/WR1096.html> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Bittker, B.I. and Rahdert, G.K., “The Exemption of Nonprofit Organizations from Federal Income Taxation,” Yale Law Journal 85, no. 3 (1976): 299-358.Google Scholar
Castro, A.I., “Overview of the Tax Treatment of Nonprofit Hospitals and Their For-Profit Subsidiaries: A Short-Sighted View Could Be Very Bad Medicine Comment,” Pace Law Review 15, no. 2 (1995): 501-538.Google Scholar
U.S. Department of the Treasury, Internal Revenue Service, Revenue Ruling 56-185, 1965-1 C.B. 202, 203, available at <https://www.irs.gov/pub/irs-tege/rr56-185.pdf> (last visited July 24, 2018). See generally Crossley, M., “Non-Profit Hospitals, Tax Exemption and Access for the Uninsured,” Pittsburgh Journal of Environmental and Public Health Law 2 (2008): 53-59.Google Scholar
U.S. Code § 170 (2013).Google Scholar
Rosenbaum, S. et.al., “The Value of the Nonprofit Hospital Tax Exemption Was $24.6 Billion in 2011,” Health Affairs 34, no. 7 (2015): 1225-1233.Google Scholar
James, J., “Nonprofit Hospitals’ Community Benefit Requirements,” Health Affairs Health Policy Brief, February 25, 2016, DOI: 10.1377/hpb20160225.954803>..>Google Scholar
See Rosenbaum, supra note 2; James, supra note 14.Google Scholar
See Rosenbaum, supra note 2.Google Scholar
See 2014 Hospital Schedule H instructions, available at <http://www.irs.gov/pub/irs-pdf/i990sh.pdf> (last visited July 24, 2018); U.S., Department of the Treasury, Internal Revenue Service, Schedule H (Form 990), Washington, DC (2017) available at <https://www.irs.gov/pub/irs-pdf/f990sh.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018);+U.S.,+Department+of+the+Treasury,+Internal+Revenue+Service,+Schedule+H+(Form+990),+Washington,+DC+(2017)+available+at++(last+visited+July+24,+2018).>Google Scholar
Id.; see also Spicer, Laura A et al., “Hospital Community Benefits after the Aca: The Emerging Federal Framework,” Hilltop Institute (2011), available at <http://hdl.handle.net/10244/1011> (last visited July 23, 2018).+(last+visited+July+23,+2018).>Google Scholar
See Davis, supra note 7.Google Scholar
26 U.S.C.A. §501(r)(3)(B) (2010).Google Scholar
Crossley, M., “Health and Taxes: Hospitals, Community Health and the IRS,” Yale Journal of Health Policy, Law, and Ethics 16, no. 1 (2016): 51-110.Google Scholar
Congressional Budget Office, Nonprofit Hospitals and the Provision of Community Benefits (Washington, D.C.: December 2006), available at <https://www.cbo.gov/sites/default/files/109th-congress-2005-2006/reports/12-06-nonprofit.pdf> (last visited July 24, 2018); Government Accountability Office, Nonprofit Hospitals Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements (Washington, DC: September 2008), available at <https://www.gao.gov/new.items/d08880.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018);+Government+Accountability+Office,+Nonprofit+Hospitals+Variation+in+Standards+and+Guidance+Limits+Comparison+of+How+Hospitals+Meet+Community+Benefit+Requirements+(Washington,+DC:+September+2008),+available+at++(last+visited+July+24,+2018).>Google Scholar
See Crossley, supra note 22; Nelson, G. D. et al., Community Benefit State Law Profiles,(Baltimore, MD: The Hilltop Institute, UMBC, January, 2015), available at <https://www.hilltopinstitute.org/our-work/hospital-community-benefit/hospital-community-benefit-state-law-profiles/> (last visited July 23, 2018).Google Scholar
See Crossley, supra note 22 at 64; U.S., Department of the Treasury, Internal Revenue Service, 2015 IRPAC Public Report, (Washington DC, 2015), available at <https://www.irs.gov/tax-professionals/2015-irpac-public-report> (last visted July 24, 2018).+(last+visted+July+24,+2018).>Google Scholar
See Department of the Treasury, Internal Revenue Service, Schedule H (Form 990), (Washington DC: 2017) available at <https://www.irs.gov/pub/irs-pdf/f990sh.pdf>..>Google Scholar
Tahk, S. C., “Tax-Exempt Hospitals & Their Communities,” Columbia Journal of Tax Law 6 no.1 (2014): 33-85.Google Scholar
Alberti, P.M., Sutton, K.M. and Baker, M., “Changes in Teaching Hospitals’ Community Benefit Spending After Implementation of the Affordable Care Act,” Academic Medicine, Volume Publish Ahead of Print (May 22, 2018), available at <https://journals.lww.com/academicmedicine/Abstract/publishahead/Changes_in_Teaching_Hospitals__Community_Benefit.97897.aspx> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Frieden, T.R., “A Framework for Public Health Action: The Health Impact Pyramid,” American Journal of Public Health 100, no. 4 (2010): 590-595.Google Scholar
Druckman, D., Doing Research: Methods of Inquiry for Conflict Analysis (Thousand Oaks: SAGE Publications, 2005)..CrossRefGoogle Scholar
UIS Survey Research Office, “Sangamon County Community Health Needs Assessment Analysis of Public Input from Community Forums and Survey,” December 2, 2014, available at <http://www.scdph.org/wp-content/uploads/2015/01/CHNA_FinalFullReport_12_2.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Health Research and Educational Trust, “Hospital-based Strategies for Creating a Culture of Health,” Health Research and Educational Trust, October 2014, available at <http://www.hpoe.org/Reports-HPOE/hospital_based_strategies_creating_culture_health_RWJF.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
County reports can be viewed at the website of the Illinois Department of Public Health, available at <https://iquery.illinois.gov/iquery/> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Norris, S.L. et.al., “Effectiveness of Self-Management Training in Type 2 Diabetes,” Diabetes Care 24, no. 3 (2001): 561-587; Clark, M.L. and Utz, S.W., “Social Determinants of Type 2 Diabetes and Health in the United States,” World Journal of Diabetes 5, no. 3 (2014): 296-304.Google Scholar
de Fátima Ferreira Grillo, M. et al., “Effect of Different Types of Self-Management Education in Patients with Diabetes,” Revista da Associação Médica Brasileira (English Edition) 59, no. 4 (2013): 400-405.Google Scholar
Gottlieb, L.M. et al., “A Systematic Review of Interventions on Patients' Social and Economic Needs,” American Journal of Preventive Medicine 53, no. 5 (2017): 719-729.Google Scholar
Seligman, H.K. et.al., “Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants,” The Journal of Nutrition 140, no. 2 (2010): 304-310; Gucciardi, E. et.al., “The Intersection between Food Insecurity and Diabetes: A Review,” Current Nutrition Reports 3, no. 4 (2014): 324-332.Google Scholar
Diez-Roux, A.V. et al., “Neighbourhood Differences in Diet: The Atherosclerosis Risk in Communities (ARIC) Study,” Journal of Epidemiology & Community Health 53, no. 1 (1999): 55-63; See Health Research and Educational Trust, supra note 35.Google Scholar
Prybil, L. et.al., “Improving Community Health Through Hospital-Public Health Collaboration: Insights and Lessons Learned from Successful Partnerships,” Health Management and Policy Faculty Book Gallery 2 (2014), available at <https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1001&context=hsm_book> (last visited July 24, 2018).Google Scholar
Angel Medical Center, “Macon County 2015 Community Health Assessment,” Macon County Public Health, 2015, available at <https://www.maconnc.org/images/healthy-carolinians/Macon%20County%202015%20Community%20Health%20Assessment.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
Exworthy, M., “Policy to Tackle the Social Determinants of Health: Using Conceptual Models to Understand the Policy Process,” Health Policy and Planning 23, no. 5 (2008): 318-327.Google Scholar
See Barnett, supra note 6.CrossRefGoogle Scholar
Community Health Roundtable, Better Housing for Healthier Children: A Report by the Community Health Roundtable, Springfield, Illinois, March 2018, available at <http://files.sj-r.com/media/news/BetterHousing.pdf> (last visited July 24, 2018).+(last+visited+July+24,+2018).>Google Scholar
See Barnett, supra note 6.Google Scholar
Young, G.J. et al., “Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA,” Health Affairs 37, no. 1 (2018): 121-124.Google Scholar
Lantz, P. M. et al., “Health Policy Approaches To Population Health: The Limits Of Medicalization,” Health Affairs 26, no. 5 (2007): 1253-1257.Google Scholar
Hood, E., “Dwelling Disparities: How Poor Housing Leads to Poor Health,” Environmental Health Perspectives 113, no. 5 (2005), doi:10.1289/ehp.113-a310.Google Scholar
Internal Revenue Service, supra note 3.Google Scholar
4
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Role of Community Health Needs Assessments in Medicalizing Poverty
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The Role of Community Health Needs Assessments in Medicalizing Poverty
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The Role of Community Health Needs Assessments in Medicalizing Poverty
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *