Since 2012, the Affordable Care Act has mandated that nonprofit hospitals publicly release a community health needs assessment at least every three years, evaluating the health of the communities they serve. According to a new Health Affairs study, however, the broad latitude given to hospitals to interpret the regulations has resulted in inconsistency when it comes to bridging health disparities.
As a result, bridging the health gap between certain groups -- defined by race, ethnicity, wealth and power -- hasn't been as effective as it could be, particularly in cities, where 62.7 percent of Americans live.
Largely, nonprofit hospitals are aware of the problem of health disparities. A full 94 percent of the hospitals included in the study adhered to the ACA requirement to publicly release a community health needs assessment, and 100 percent of them mentioned health inequity implicitly. Moreover, 65 percent mentioned inequity explicitly.
Yet only 9 percent of the hospitals that had a publicly available implementation strategy actually describes any activity to address health inequities.
More than 75 percent of hospitals reported that external stakeholders identified health equity as a need. But just 46 percent prioritized health equity in their community needs assessments, suggesting that while hospitals may be comfortable broaching the topic, they may be more reluctant to declare it a priority, according to the study.
Similarly, only 49 percent of the community health needs assessments provided any discussion of the causes of health inequities in their respective communities. The implication, according to the study's authors, is that any mention of health equity in those assessments is perfunctory, lacking an understanding of inequity's underlying causes -- and dooming from the start any strategies that would address them.
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Researchers identified a potential reason for nonprofit hospitals' inconsistent efforts: that these facilities have the will to promote health equity, but not necessarily the know-how. To overcome this challenge, they said, hospitals could collaborate with other facilities or health systems that are already implementing successful population health initiatives, gleaning knowledge and insight from data sharing and best practices.
The study was prompted by questions in recent years about whether nonprofit hospitals are providing enough community benefit to justify their tax-exempt status. In 2011, less than 8 percent of community benefit spending went toward community improvement activities, researchers said.
Twitter: @JELagasse