Tax-Exempt Hospitals and Community Health under the Affordable Care Act: Identifying and Addressing Unmet Legal Needs as Social Determinants of Health

Crossley, Mary; Tyler, Elizabeth Tobin; Herbst, Jennifer L.

doi:10.1177/003335491613100127

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…14 MLPs can inform health care and public health partners about the legal needs and structural barriers experienced by the target population and provide recommendations for a community-based implementation strategy to address those needs. 15 These strategies also inform how tax-exempt hospitals allocate community benefit funds and often help to focus hospitals on more upstream interventions, rather than pure downstream charity care. In addition to tax-exempt hospitals, community health centers and other safety-net providers regularly engage in health needs assessments and quality improvement studies.…”

Section: Opportunities For Mlp–public Health Collaboration To Improvementioning

confidence: 99%

Medical-Legal Partnership: A Powerful Tool for Public Health and Health Justice

Tobin-Tyler

Teitelbaum

2019

Public Health Rep

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Section: Opportunities For Mlp–public Health Collaboration To Improvementioning

confidence: 99%

Medical-Legal Partnership: A Powerful Tool for Public Health and Health Justice

Tobin-Tyler

Teitelbaum

2019

Public Health Rep

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“…These findings have practical implications for assessing social needs. As more health care providers seek to assess social needs (Alley, Asomugha, Conway, & Sanghavi, 2016; Andermann, 2016; Crossley, Tyler, & Herbst, 2016; Fierman et al, 2016; Gottlieb, Wing, & Adler, 2017; McMullen & Katz, 2017), reliance on proactive use of online tools may lead to sampling bias. Providers and health plans must ensure that tools to assess social needs are accessible to all patients, even those not comfortable with technology.…”

Section: Discussionmentioning

confidence: 99%

Social Needs and Health-Related Outcomes Among Medicaid Beneficiaries

et al. 2019

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Unmet social needs—including food, housing, and utilities—have been associated with negative health outcomes, but most prior research has examined the health associations with a single unmet need or analyzed samples that were homogeneous along one or more dimensions (e.g., older adults or patients with chronic health conditions). We examined the association between unmet social needs and psychosocial and health-related outcomes in a sample of Medicaid beneficiaries from 35 U.S. states. In 2016-2017, 1,214 people completed an online survey about social needs, demographics, and health-related and psychosocial outcomes. Seven items assessing social needs formed an index in which higher scores indicated higher levels of unmet needs. Participants were eligible if they were ≥18 years and had Medicaid. The sample was predominantly female (87%). Most (71%) lived with at least one child ≤18 years, and 49% were White and 33% were African American. Average age was 36 years (SD = 13). The most common unmet needs were not enough money for unexpected expenses (54%) and not enough space in the home (25%). Analyses controlling for recruitment method and demographics showed that increasing levels of unmet social needs were positively associated with stress, smoking, and number of chronic conditions, and negatively associated with future orientation, attitudes toward prevention, days of exercise/week, servings of fruits or vegetables/day, and self-rated health (all p < .01). Results add to the evidence about the relationship between unmet social needs and health. Interventions to help meet social needs may help low-income people improve both their economic situations and their health.

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“…In the latter scenario, there seems to be room for hospitals to expand their reach beyond serving the acute care needs of patients to playing a more prominent role in public health. Specifically, becoming accountable to more than patients may lead hospitals to focus on the social determinants of health in addition to preventing acute and chronic illnesses (Alberti, 2015;Crossley, Tyler, & Herbst, 2016). Both approaches, however, are consistent with a realist approach to evaluation since empirical indicators are often used to locate the boundaries of a community.…”

Section: Discussionmentioning

confidence: 99%

Defining “Community” in Community Health Evaluation

Franz

Skinner

Murphy

2017

American Journal of Evaluation

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This article examines the theoretical basis of the community as it is evoked in health evaluation. In particular, we examine how hospitals carrying out Community Health Needs Assessments (CHNAs) define communities as well as the implications for these definitions for how to study and engage community problems. We present qualitative findings from a sample of Appalachian nonprofit hospitals, who we asked to describe their approach to defining the community in their most recent Internal Revenue Service–mandated CHNA. Drawing upon a theoretical debate in the history of evaluation research, the authors argue that the contemporary community cannot be circumscribed merely by geographic boundaries, nor can it be identified easily with a bounded group of clearly demarcated individuals. Instead, following the tenets of community-based health research, the authors argue for a richer, more dynamic conceptualization of the community in evaluation research in which definitions arise from community bodies themselves.

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Tax-Exempt Hospitals and Community Health under the Affordable Care Act: Identifying and Addressing Unmet Legal Needs as Social Determinants of Health

Cited by 9 publications

References 6 publications

Medical-Legal Partnership: A Powerful Tool for Public Health and Health Justice

Medical-Legal Partnership: A Powerful Tool for Public Health and Health Justice

Social Needs and Health-Related Outcomes Among Medicaid Beneficiaries

Defining “Community” in Community Health Evaluation

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