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dc.contributor.advisorLindrooth, Richard
dc.contributor.advisorTung, Gregory J.
dc.contributor.authorSantos, Tatiane
dc.contributor.committeememberAdams, Jimi
dc.contributor.committeememberLee, Shoou-Yih D.
dc.contributor.committeememberEast, Chloe
dc.date.accessioned2020-01-14T15:44:31Z
dc.date.available2020-01-14T15:44:31Z
dc.date.submitted2020
dc.descriptionIncludes bibliographical references.
dc.descriptionFall
dc.description.abstractNonprofit hospitals (NFP) must provide certain types of community benefit (CB) in order to keep their tax-exempt status. The IRS reported that NFPs spent over $60 billion on CB activities in 2011. NFPs have dedicated most of their CB dollars to charity care. Section 9007 of the ACA falls under IRS CB regulation and is a promising regulatory approach to steer NFPs towards providing community health activities that fall outside its acute care focus. It required NFPs to submit a triennial community health needs assessment and an implementation strategy. A few states leverage Section 9007 to encourage collaboration between NFPs and local health departments (LHD). New York is the only state that has required NFPs and LHD to collaborate in local health planning. Despite this trend in which states either require or encourage NFPs and LHDs to collaborate, there is little evidence of the impact of collaboration on NFP CB spending and community health outcomes. Leveraging the implementation of Section 9007 and the NY requirement, we estimated difference-in-differences specifications which compared the change in the study’s two main outcomes (population health spending and drug-induced mortality) pre and post policy implementation. We also used random effects regression models to understand the association between community social capital and drug-induced mortality. We found that NFP-LHD collaboration was associated with an incremental increase in population health spending of approximately $260,000 per NFF. We also found that NPF-LHD collaboration in local health planning led to an incremental decrease in drug-induced mortality of approximately 4 deaths per 100,000 residents. Finally, we did not find strong evidence that LHD social capital was associated with mortality and intermediate outcomes. The CB requirement for NFPs presents an opportunity to increase NPF collaboration with LHDs to improve population health. Some states have recognized the potential benefits of NPF-LHD collaboration and have implemented policies to require collaboration. New York was the first state to require this type of collaboration and our study results suggest that it can lead to increased population health investment by NPFs and improved community health outcomes.
dc.identifierSantos_ucdenveramc_1639D_10700.pdf
dc.identifier.urihttps://hdl.handle.net/10968/4779
dc.languageEnglish
dc.publisherUniversity of Colorado at Denver, Anschutz Medical Campus. Health Sciences Library
dc.rightsCopyright of the original work is retained by the author.
dc.subjectcommunity benefit
dc.subjectlocal health department
dc.subjectnonprofit hospital
dc.subject.meshCommunity Health Services
dc.subject.meshPopulation Health
dc.subject.meshHealth Care Reform
dc.subject.meshPatient Protection and Affordable Care Act
dc.titleIs collaboration between nonprofit hospitals and local health departments effective? An analysis of hospital community benefit activities
dc.typeThesis
thesis.degree.disciplineHealth Services Research, Policy & Administration
thesis.degree.grantorUniversity of Colorado at Denver, Anschutz Medical Campus
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Philosophy (Ph.D.)


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