A new study finds urban, nonprofit hospitals and their communities recognize the role of health disparities in overall outcomes and are working to reduce such inequities, but could use additional incentives and capacity to make greater improvements.
The study, by researchers at Drexel University’s School of Public Health, is one of the first to examine the connection between community benefit and population health to evaluate health equity needs in hospitals’ communities. Specifically, the study sought to understand the extent to which urban, nonprofit hospitals used a health equity lens when assessing and addressing community needs. The findings of the study could be particularly pertinent America’s Essential Hospital members, of which roughly 95 percent are urban hospitals and 50 percent are nonprofit hospitals.
For the study, researchers conducted an analysis of publicly available community health needs assessments (CHNAs) and related implementation plans for 179 hospitals in 28 cities from August–December 2016. Nonprofit hospitals are required to complete CHNAs under the Affordable Care Act.
Researchers defined health equity as “the absence of systematic disparities in health (or in major social determinants of health) between groups with different levels of underlying social advantage/disadvantage — that is, wealth, power, or prestige.” Using this definition, researchers identified 15 implicit terms (i.e. disparities, vulnerable, social determinants) and four explicit terms (i.e. equity, inequity) indicating some connection to health equity. They also created a framework of six “health equity elements” that, if found in a CHNA or implementation plan, discerned a more meaningful connection and understanding.
All CHNAs in the study used at least one implicit health equity term, 65 percent used an explicit health equity term, and the majority contained one of the health equity elements. However, only 9 percent of implementation plans included specific activities dedicated to addressing inequity.
The findings show that urban, nonprofit hospitals and their communities overwhelmingly recognize health disparities and some are implementing processes to reduce them. Researchers concluded that the findings also show that hospitals need incentives and capacity to truly improve the structural inequities in their communities — something that may be possible through future alignment of community benefit requirements and CHNA reporting practices.