政策要点医院通过提供社会护理服务来解决人口健康需求和患者健康的社会决定因素。免税医院必须投资于社区福利,包括社会关怀服务计划,尽管大多数社区福利支出都是针对未偿还的医疗保健服务。免税医院提供的社会护理服务比营利性医院高出约36%。在免税医院中,那些为社区福利支出分配更多资源的人提供了更多类型的社会护理服务,但是那些在社区福利支出要求最低的州提供更少的社会护理服务。政策制定者可能会考虑特别激励社区福利支出用于特定的社会护理服务,包括将免税与实施挂钩,利用率,和成果目标,更直接地帮助患者。
背景:尽管人们对确定患者的社会需求越来越感兴趣,人们对医院提供服务来解决这些问题知之甚少。我们确定美国医院提供的社会护理服务,并确定医院支出或针对社区福利的国家政策是否与免税医院提供这些服务有关。
方法:从美国医院协会年度调查中收集了有关医院的国家二级数据,来自CommunityBenefitInsight.org的关于社区福利支出的额外国税局(IRS)表格990数据和来自HilltopInstitute.org的州一级社区福利政策。计算了社会护理服务类型和医院特征的描述性统计数据,用双变量卡方检验和t检验比较营利性医院和免税医院。多变量Poisson回归用于估计医院特征与所提供服务类型之间的关联以及免税医院之间的关联,以估计社会护理服务与社区福利支出和政策之间的关联。多变量逻辑回归对社区福利支出/政策与每种类型的社会护理服务之间的关联进行了建模。
结果:美国私立医院在2018年平均提供5.7种社会护理服务。免税医院提供的社会护理服务比营利性医院高出约36%。床的数量较大,卫生系统隶属关系,建立社区伙伴关系与更多的社会护理服务有关,而农村医院和按合同管理的医院提供的社会护理服务较少。在免税医院中,更大的社区福利支出与提供更多的总服务(发病率比率[IRR]=1.10,p<0.01)和以患者为中心的社会护理服务(IRR=1.16,p<0.01)相关.社区福利支出要求最低的州的医院提供的社会护理服务明显减少。
结论:尽管免税地位和增加的社区福利支出与增加的社会护理服务有关,观察到某些医院特征和州最低社区福利支出要求与较少的社会护理服务相关,这表明政策改革有机会增加社会护理服务的实施.
Policy Points Hospitals address population health needs and patients\' social determinants of health by offering social care services. Tax-exempt hospitals are required to invest in community benefits, including social care services programs, though most community benefits spending is toward unreimbursed health care services. Tax-exempt hospitals offer about 36% more social care services than for-profit hospitals. Among tax-exempt hospitals, those that allocate more resources to community benefits spending offer more types of social care services, but those in states with minimum community benefits spending requirements offer fewer social care services. Policymakers may consider specifically incentivizing community benefits expenditures toward particular social care services, including linking tax exemptions to implementation, utilization, and outcome targets, to more directly help patients.
Despite growing interest in identifying patients\' social needs, little is known about hospitals\' provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax-exempt hospitals.
National secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state-level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi-square and t-tests comparing for-profit and tax-exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax-exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services.
Private US hospitals offered an average of 5.7 types of social care services in 2018. Tax-exempt hospitals offered about 36% more social care services than for-profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax-exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient-focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services.
Although tax-exempt status and increased community benefits spending were associated with increased social care services provision, the observation that certain hospital characteristics and state minimum community benefits spending requirements were associated with fewer social care services suggests opportunities for policy reform to increase social care services implementation.