title: Analysis of hospital community benefit expenditures' alignment with community health needs: evidence from a national investigation of tax-exempt hospitals.
abstract: OBJECTIVE
  We investigated whether federally tax-exempt hospitals consider community health needs when deciding how much and what types of community benefits to provide.
  
  
  METHODS
  Using 2009 data from hospital tax filings to the Internal Revenue Service and the 2010 County Health Rankings, we employed both univariate and multivariate analyses to examine the relationship between community health needs and the types and levels of hospitals' community benefit expenditures. The study sample included 1522 private, tax-exempt hospitals throughout the United States.
  
  
  RESULTS
  We found some patterns between community health needs and hospitals' expenditures on community benefits. Hospitals located in communities with greater health needs spent more as a percentage of their operating budgets on benefits directly related to patient care. By contrast, spending on community health improvement initiatives was unrelated to community health needs.
  
  
  CONCLUSIONS
  Important opportunities exist for tax-exempt hospitals to improve the alignment between their community benefit activities and the health needs of the community they serve. The Affordable Care Act requirement that hospitals conduct periodic community health needs assessments may be a first step in this direction.
authors: Simone R. Singh, Shoou-Yih Daniel Lee, and Jeffrey A. Alexander are with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Gary J. Young is with the Northeastern University Center for Health Policy and Health Care Research and the Department of Strategic Management and Health Care Systems, D'Amore-McKim School of Business and Bouve College of Health Sciences, Boston, MA. Paula H. Song is with the Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill.
authors: Simone R
authors: SR
authors: Singh
authors: Gary J
authors: GJ
authors: Young
authors: Shoou-Yih
authors: SY
authors: Daniel Lee
authors: Paula H
authors: PH
authors: Song
authors: Jeffrey A
authors: JA
authors: Alexander
mesh_terms: D006266:Health Education / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000191:economics; D006301:Health Services Needs and Demand; D006764:Hospitals, Community / Q000191:economics*; D006788:Hospitals, Voluntary / Q000191:economics*; D006801:Humans; D008484:Medicaid / Q000191:economics; D005791:Patient Care / Q000191:economics; D019464:Tax Exemption; D017664:Uncompensated Care / Q000191:economics; D014481:United States