Association Between Comprehensiveness of Nonprofit Hospitals’ Health Equity Strategies and Their Community Benefit Spending

This study examined the relationship between the comprehensiveness of nonprofit hospitals' health equity strategies and their community benefit spending. Health equity strategies were measured using data from the American Hospital Association's Annual Survey and included indicators of equitable and inclusive organizational policies; systematic and shared accountability for health equity; diverse representation in hospital leadership and governance; community engagement; collection and use of segmented data to drive action; and culturally appropriate patient care. Community benefit spending was measured using data from Internal Revenue Service (IRS) Form 990 Schedule H. Among 984 hospitals with complete data for the year 2022, those with the most comprehensive health equity strategies dedicated more resources to traditional clinical community benefits-including charity care and Medicaid payment shortfalls-while spending less on subsidized health services. These hospitals also consistently invested more in population health-related community benefits, such as community health improvement programs, community building activities, and cash or in-kind contributions. These findings suggest that robust health equity strategies are linked to greater investment in both clinical needs and broader determinants of community health.