Alignment of Community Benefit Spending and Initiatives to Improve Community Health: Is There Evidence of Progress?

Objectives We sought to identify changes in non-profit hospitals’ community benefit spending from 2014 to 2019. Secondly, we wanted to find novel predictors of spending in the most recent available data. Methods For our longitudinal analysis, we used tax filing data for 1072 hospitals from 2014-2019 and time-based ANOVA. We gathered information about hospital characteristics, the social determinants of health, and hospital partnerships with local communities for 1192 hospitals for the year 2019. We employed multivariate regression to identify significant factors. Results Total community benefit spending rose from 8.1% in 2014 to 9.1% of operating expenses in 2019, driven by increased spending on patient care. There was no such increase in spending on activities targeted at improving community health. The presence and strength of partnerships between hospitals and their communities were associated with higher community benefit spending. Conclusions We found no evidence of dramatic shifts in community benefit spending from 2014 to 2019. Further, we identified partnerships for population health improvement as an effective, novel predictor of community benefit spending. Supporting partnerships between hospitals and communities may help facilitate strategic investments in community health improvement. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was supported by a Seed Grant awarded by the Office of the Executive Vice President for Research at the Georgia Institute of Technology. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All publicly available data can be gathered using to tools available at: Additional data can be purchased from the American Hospital Assocation