State reporting requirements and non-profit hospital community benefit spending

In this paper, we examined whether state community benefit reporting laws were associated with non-profit hospital community benefit spending. We hypothesized that hospitals in states with these requirements would spend a greater proportion of their total operating expenses on community benefits. In addition, we considered that levels of charity care spending would be more influenced by community needs than by laws. Therefore, we also hypothesized that the increase in overall spending due to state laws would be driven by spending on community benefit activities focused on public and population health rather than direct hospital care provision.;The dependent variables were the percent of hospitals' total expenses that went towards (1) overall community benefit spending, (2) at-cost charity care spending, and (3) population-oriented health efforts. Accounting for correlation within hospital referral regions, we modeled each dependent variable as a function of state reporting laws, as well as hospital and market characteristics that may include drivers of community benefit spending.;Over 3,100 non-profit hospital facilities that submitted community benefit data to the IRS via Form 990 and Schedule H from 2009-2011.;On average, non-profit hospitals spent 7.8% of their total expenses on any community benefits, 2.2% on at-cost charity care benefits, and 2.6% on population health benefits. While there was a significant relationship between reporting laws and spending for hospitals that were not dependent on Medicaid for revenue, this was not the case for Medicaid-dependent hospitals (p=.688). Among the former, the presence of a state reporting requirement was associated with a 12.4% increase in the percent of total expenses dedicated to community benefits (p=.001). This increase was driven by population-oriented benefit spending; there was no significant relationship between reporting requirements and charity care spending (p=.335), but the spending ratio for alternate community benefits was 14.4% greater when hospitals were in states with such a requirement (p=.039).;Overall, state reporting laws were correlated with increased hospital spending on community benefit activities. These laws appear to be most impactful on hospitals with greater financial flexibility and activities related to public and population health rather than direct care provision.