Nonprofit Hospital Community Benefits: Collaboration With Local Health Departments to Address the Drug Epidemic

Abstract

Background: Nonprofit hospitals (NFPs) are required to provide community benefits, which have been historically focused on provision of medical care, to keep their tax exemption status. To increase hospital investment in community health, the Patient Protection and Affordable Care Act required NFPs to conduct community health needs assessments and address identified needs. Some states have leveraged this provision to encourage collaboration between NFPs and local health departments (LHDs) in local health planning.

Objective: The objective of this study was to examine the association of NFP-LHD collaboration in local health planning targeting drug use, with drug-induced mortality.

Research design: We conducted difference-in-differences analyses using drug-induced mortality data from 2009 to 2016, encompassing the first 3 years after NFP-LHD collaboration in local health planning specific to drug use. We evaluated drug-induced mortality in 22 counties in which collaboration was required in comparison with that in 198 control counties. We used data collected from implementation strategy reports by NFPs and combined it with data on hospital characteristics, as well as state-level and county-level factors associated with drug-induced mortality.

Measures: The primary outcome was county-level drug-induced mortality per 100,000 population.

Results: Counties, in which NFP-LHD collaboration in local health planning was required and in which NFPs and LHDs jointly prioritized drug use, experienced a deceleration in drug-induced mortality of ~8 deaths per 100,000 population compared with the mortality rate they would have experienced without collaboration.

Conclusions: Collaboration between NFPs and LHDs to address drug use was associated with a deceleration in drug-induced mortality. Policymakers can leverage community benefit regulation to encourage NFP-LHD collaboration in local health planning.

Figure 1.

Geographic Distribution of Study Treatment Groups Notes: Authors’ analysis of qualitative data from nonprofit hospital implementation strategy reports completed in 2012 and 2013. NOTES: Orange coloring is used for control counties and green coloring for treatment counties. Both orange and green-colored counties on the map indicate that at least one nonprofit hospital selected drug use as a health priority. Additionally, green-colored counties indicate that nonprofit hospitals and LHDs jointly selected drug use as a health priority and collaborated to implement interventions to address it. NY indicates New York.