Cronin Cory E, Singh Simone, Franz Berkeley
Health Care Manage Rev. 2022;47(1):E11-E20. doi: 10.1097/HMR.0000000000000305.
In 2014, Maryland established a global budget policy for all hospitals in the state. Under this policy, hospitals are incentivized to not only provide clinical care services to individual patients but also address the health needs of their broader patient population through prevention efforts and investment in the upstream social and economic factors that determine health.
To better understand the incentives created for hospitals under this policy, our study assessed whether the implementation of global budgets changed the levels and patterns of Maryland hospitals' investments in community benefits.
Data on hospital community benefit spending from the Internal Revenue Service Form 990 Schedule H for the years 2010-2016 were utilized for this study.
We found that Maryland hospitals' total spending on community benefits decreased under the global budget policy. Unlike hospitals in similar states without a global budget policy, Maryland hospitals did not experience any increases in Medicaid shortfalls between 2014 and 2016. Although Maryland hospitals provided more subsidized health services, their investment in broader community health improvement activities remained unchanged.
Our analysis suggests that Maryland hospitals have shifted strategies because of the implementation of the global budget policy. The ability to report community benefit in a way that accurately considers the context and constraints of a state's policies would provide hospitals better means of communicating these efforts to stakeholders.
Our results suggest that global budgets impact the levels and patterns of hospitals' community benefit investments.
2014年，马里兰州为该州所有医院制定了一项全球预算政策。根据这项政策，激励医院不仅要为个体患者提供临床护理服务，还要通过预防措施以及对决定健康状况的上游社会和经济因素进行投资，来满足更广泛患者群体的健康需求。
为了更好地理解该政策为医院创造的激励措施，我们的研究评估了全球预算的实施是否改变了马里兰州医院在社区福利方面的投资水平和模式。
本研究使用了美国国税局990表H中2010 - 2016年医院社区福利支出的数据。
我们发现，在全球预算政策下，马里兰州医院在社区福利方面的总支出有所下降。与没有全球预算政策的类似州的医院不同，2014年至2016年期间，马里兰州的医院医疗补助缺口没有增加。尽管马里兰州的医院提供了更多补贴性医疗服务，但它们在更广泛的社区健康改善活动上的投资保持不变。
我们的分析表明，由于全球预算政策的实施，马里兰州的医院已经改变了策略。以一种能够准确考虑到一个州政策的背景和限制的方式来报告社区福利，将为医院向利益相关者传达这些努力提供更好的途径。
我们的结果表明，全球预算会影响医院社区福利投资的水平和模式。
