New Community Benefit policies can reinforce the commitment of nonprofit hospitals to both community health and health disparities, according to a study published in the AMA Journal of Ethics.

Current Community Benefit regulations fall short of directing the activity of nonprofit hospitals toward developing community-based health improvements. The investigators of this study sought to influence changes to federal policy that would improve Community Benefit efforts that respond to a community’s specific health disparities.

According to the IRS, approximately 92% of the budget spent on Community Benefit in 2011 went toward activities related to clinical care, and less than 8% was divided between community health improvement and community group contributions. Although clinical care serves an important need, it is rarely the most effective activity that influences community-wide health. The investigators suggest that community health and health equity become more central goals of Community Benefit, and recommend 4 changes to federal policy that will help prioritize community health needs and foster greater collaboration with key community partners.

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Collaborate on Implementation Strategies

The investigators recommend engaging community partners to help in the assessment of community health needs, and in forming, and regularly revising, an implementation strategy that addresses concerns of community health and health equity.

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Assess Needs Every 5 Years

Currently, nonprofit hospitals are required to conduct a community health needs assessment every 3 years. The investigators suggest changing this requirement to every 5 years in order to allow time to see meaningful change in health outcomes between cycles. Longer cycles also provide time for hospitals and health departments to align and collaborate, which would facilitate more coordinated efforts to improve community health and make hospitals more accountable to the public.

Include Community-Building Activities as Community Benefit

The investigators recommend that IRS Form 990 Schedule H instructions clarify that community-building activities are included as Community Benefit. All activities related to the social determinants of health (improvements to housing, economic development, and addressing environmental hazards) should be counted toward a nonprofit hospital’s total Community Benefit spending, as these efforts can significantly improve health.

Make Addressing Health Disparities an Explicit Goal

Community health needs assessments should be required to include a description of the most concerning health disparities facing the community and the role nonprofit hospitals should play in their remediation. Implementation strategies should explicitly state how the hospital intends to address these disparities and how they will measure outcomes.


Rozier M, Goold S, Singh S. How should nonprofit hospitals Community Benefit be more responsive to health disparities? AMA J Ethics. 2019;21(3):E273-280.