The contribution of hospitals and health care systems to community health.
This article reviews evidence on hospitals' and health systems' impacts on community health improvement. We begin with an overview of the history of community benefit and then discuss the lack of a widely accepted definition and measurement of community benefit activities as well as the expectations and accountability of tax-exempt not-for-profit hospitals and health systems in community initiatives. We highlight the approaches of two systems and identify strategic, cultural, technical, and structural challenges associated with increasing community benefit and health-improvement activities. We conclude by offering recommendations for policy and practice.
Shortell
Stephen M
SM
University of California, Berkeley, School of Public Health, Berkeley, California 94720, USA. shortell@berkeley.edu
Washington
Pamela K
PK
Baxter
Raymond J
RJ
D003153:Community Health Services / Q000379:methods*; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D006293:Health Promotion; D006297:Health Services Accessibility; D006739:Hospital Administration; D006761:Hospitals; D006788:Hospitals, Voluntary / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D008329:Managed Care Programs; D014481:United States