State-level community benefit regulation and nonprofit hospitals' provision of community benefits

Simone R. Singh, Gary J. Young, Lacey Loomer, Kristin Madison

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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 minimumincomeeligibility 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.

Original languageEnglish (US)
Pages (from-to)229-269
Number of pages41
JournalJournal of health politics, policy and law
Issue number2
StatePublished - Apr 1 2018
Externally publishedYes

Bibliographical note

Funding Information:
Simone R. Singh is assistant professor of health management and policy at the University of Michigan School of Public Health. Her research focuses on tax-exempt hospitals’ provision of community benefits, hospital-public health partnerships, and the role of such partnerships in improving population health outcomes. She has authored more than thirty articles, which have appeared in American Journal of Public Health, American Journal of Preventive Medicine, Health Services Research, and Public Health Reports, among other venues. Gary J. Young is director of the Northeastern University Center for Health Policy and Healthcare Research and professor of Strategic Management and Health Systems at Northeastern University. His research focuses on organizational, managerial, and legal issues associated with the delivery of health care services. He has received funding for his research from a number of private and public organizations, including the National Science Foundation, the Robert Wood Johnson Foundation, and the Agency for Healthcare Research and Quality. His articles have appeared in the following journals: New England Journal of Medicine; Journal of the American Medical Association; Journal of Health Politics, Policy and Law; Health Affairs; Medical Care; and Academy of Management Journal.

Publisher Copyright:
© 2018 by Duke University Press.


  • Community benefit
  • Nonprofit hospitals
  • State-level regulation


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