Santos Tatiane, Young Gary J, Lee Shoou-Yih, Owsley Kelsey
Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
D'Amore-McKim School of Business, Northeastern University, Boston, MA 02115, USA.
Healthcare (Basel). 2025 Jun 23;13(13):1497. doi: 10.3390/healthcare13131497.
: Community benefit (CB) obligations by not-for-profit (NFP) hospitals have attracted renewed scrutiny at federal and state levels due to wide variation in CB spending. In 2020, Oregon implemented a CB policy for all NFP hospitals that included requirements to expand patient financial assistance and a hospital-specific minimum CB spending floor. We examined trends in CB spending after the implementation of Oregon's CB policy. : Interrupted time-series analyses to compare hospital CB spending before and after policy implementation. : Overall, Oregon's CB policy was not associated with changes in CB spending, except for a 0.2% decrease in the Social Determinants of Health spending (-0.0018; < 0.05). Among hospitals in the first tercile of pre-policy CB spending, Oregon's policy was associated with a 0.4% decrease in charity care (-0.0041; < 0.05) and a 0.6% increase in subsidized health services spending (0.0063; < 0.05). Hospitals in the second tercile of pre-policy CB spending experienced a 0.7% decrease in subsidized health services (-0.0074; < 0.05). Among frontier hospitals, total CB spending and Medicaid shortfalls increased by 2.9% (0.0292; < 0.10) and 2.2% (0.0220; < 0.10) respectively, while non-frontier hospitals experienced a 0.7% decrease in Medicaid shortfall (-0.0068; < 0.05). Critical access hospitals experienced a 1.3% increase in subsidized health services spending (0.0131; < 0.05). : Although total CB spending did not change in the two years following Oregon's CB policy implementation, findings suggest that hospitals may be shifting the composition of their CB spending. Oregon's CB policy encourages proactive CB spending tailored to community needs, but opportunities exist to fine-tune the policy to boost hospital CB spending. Specifically, planned spending in categories such as charity care may alleviate the increasing burden of medical debt and its financial implications for patients.
由于社区福利（CB）支出差异很大，非营利性（NFP）医院的社区福利义务在联邦和州层面受到了新的审查。2020年，俄勒冈州对所有非营利性医院实施了一项社区福利政策，其中包括扩大患者经济援助的要求以及特定医院的最低社区福利支出底线。我们研究了俄勒冈州社区福利政策实施后社区福利支出的趋势。：采用中断时间序列分析来比较政策实施前后医院的社区福利支出。：总体而言，俄勒冈州的社区福利政策与社区福利支出的变化无关，除了健康的社会决定因素支出下降了0.2%（-0.0018；<0.05）。在政策实施前社区福利支出处于第一三分位数的医院中，俄勒冈州的政策导致慈善护理支出下降了0.4%（-0.0041；<0.05），补贴医疗服务支出增加了0.6%（0.0063；<0.05）。政策实施前社区福利支出处于第二三分位数的医院，其补贴医疗服务支出下降了0.7%（-0.0074；<0.05）。在偏远地区医院中，社区福利总支出和医疗补助缺口分别增加了2.9%（0.0292；<0.10）和2.2%（0.0220；<0.10），而非偏远地区医院的医疗补助缺口下降了0.7%（-0.0068；<0.05）。临界接入医院的补贴医疗服务支出增加了1.3%（0.0131；<0.05）。：尽管在俄勒冈州社区福利政策实施后的两年里，社区福利总支出没有变化，但研究结果表明医院可能在改变其社区福利支出的构成。俄勒冈州的社区福利政策鼓励根据社区需求进行积极的社区福利支出，但仍有机会对政策进行微调以增加医院的社区福利支出。具体而言，在慈善护理等类别上的计划支出可能会减轻医疗债务不断增加的负担及其对患者的财务影响。
