P.M. Alberti is senior director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC. K.M. Sutton is lead specialist, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC. M. Baker is senior research analyst, Health Care Affairs, Association of American Medical Colleges, Washington, DC.
Acad Med. 2018 Oct;93(10):1524-1530. doi: 10.1097/ACM.0000000000002293.
U.S. teaching hospitals that qualify as 501(c)(3) organizations (a not-for-profit designation) are required to demonstrate community benefit annually. Increases in health insurance access driven by Affordable Care Act (ACA) implementation, along with new regulations, research opportunities, and educational expectations, may be changing hospitals' allocations of community benefit dollars. This study aimed to describe changes in teaching hospitals' community benefit spending between 2012 (pre-ACA implementation) and 2015 (post-ACA implementation), and to explore differences in spending changes between hospitals in Medicaid expansion and nonexpansion states.
In 2017, for each teaching hospital member of the Association of American Medical Colleges' (AAMC's) Council of Teaching Hospitals and Health Systems required to submit Form 990s to the Internal Revenue Service, the authors sought community benefit spending data for 2012 and 2015 as reported on Schedule H.
The analysis included 169 pairs of Form 990s representing 184 AAMC member teaching hospitals (93% of 198 eligible hospitals). Compared with 2012, hospitals in 2015 spent $3.1 billion (20.14%) more on community benefit despite spending $804 million (16.17%) less on charity care. Hospitals in Medicaid expansion states increased spending on subsidized health services and Medicaid shortfalls at rates higher than hospitals in nonexpansion states. The latter increased spending at higher rates on community health improvement and cash/in-kind contributions.
After ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined. Changes in community benefit spending differed according to states' Medicaid expansion status, demonstrating hospitals' responsiveness to state and local realities.
符合 501(c)(3)组织（非营利组织）资格的美国教学医院每年都需要证明其社会效益。《平价医疗法案》（ACA）实施带来的医疗保险覆盖面增加，以及新的法规、研究机会和教育期望，可能正在改变医院社会效益资金的分配。本研究旨在描述教学医院在 2012 年（ACA 实施前）和 2015 年（ACA 实施后）之间社会效益支出的变化，并探讨在医疗补助计划扩大和未扩大的州之间，医院在支出变化方面的差异。
2017 年，作者寻求每个参加美国医学院协会（AAMC）教学医院理事会和卫生系统协会（AAMC）的教学医院成员的 990 表格数据，这些成员需要向美国国税局提交 990 表格，以获取 2012 年和 2015 年作为附表 H 报告的社会效益支出数据。
该分析包括 169 对代表 184 个 AAMC 成员教学医院（198 家合格医院中的 93%）的 990 表格。与 2012 年相比，尽管慈善护理支出减少了 8.04 亿美元（16.17%），但 2015 年医院在社会效益方面的支出增加了 31 亿美元（20.14%）。医疗补助计划扩大州的医院增加了补贴医疗服务和医疗补助短缺的支出，增长率高于非扩大州的医院。后者以更高的速度增加了社区卫生改善和现金/实物捐款的支出。
ACA 实施后，教学医院增加了整体社会效益支出，同时慈善护理支出下降。社会效益支出的变化因州的医疗补助计划扩张状况而异，这表明医院对州和地方现实的反应。
