We try to keep this blog accessible and policy relevant, and therefore carefully avoid being overly academic. However, we also regularly follow the literature, which is a challenge given the breadth of multidisciplinary scholarship underpinning the field. So periodically I will point to particularly recent and relevant articles that may be of interest to readers. The list of 11 journals we regularly scan is listed at the bottom of this post. I welcome your flagging for me other journals and articles you suggest we follow. I’m going to start this series by focusing on an article from the December 2011 issue of the American Journal of Public Health.
While the authors summarize the history of the IRS Community Benefit Standard since 1969, they primarily focus on aspects of the Affordable Care Act that have implications for this provision. One important issue is that of the threshold for what counts for meeting the community benefit standard. Currently no threshold level exists, although figures such as 5% of revenue have been suggested in the past. The authors examined the data from Maryland and found substantial variation in the amount of community benefit services provided, ranging from a minimum of 1.67% of operating expenses to a maximum of 13%, and that only 70% of hospitals met a hypothetical 5% standard. Only recently, as a result of the new 990 Schedule H, have hospitals been required to report the net value of community benefit services in the following standard categories: charity care and means-tested government programs, community health improvements, health professions education, subsidized health services, community building activities, research, and cash or in-kind contributions to community groups. As these data become available, it will be important to determine the distribution of these investments across the categories and evaluate how well they fit population health policy goals.
The authors also comment extensively on the impact of reducing the uninsured level through ACA coverage provisions on the direction of community benefit policy. They argue that “although the composition of community benefit services may change, tax-exempt status is still necessary to ensure sufficient provision of unprofitable services and those related to preventable diseases. Such preventative services have the potential to address the pressing public health problems of diabetes, obesity, and asthma….and which are designed to respond to unmet public health needs.” I am continuing to pay close attention to this evolving issue, especially as it relates to the development of dependable revenue streams for population health improvement.
Other noteworthy articles:
The Many Ways that Policymakers Use Public Health Researchers. (Haynes AS and colleagues).
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Health Affairs
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
Milbank Quarterly
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.
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