The evolving role of nonprofit hospitals and health systems in improving community health

As the healthcare landscape evolves, hospitals and health systems in the United States (U.S.) are increasingly focusing on factors beyond traditional clinical care, recognizing that social determinants such as housing, nutrition, transportation, and education profoundly influence health outcomes. Historically, hospitals primarily provided medical services within their facilities, but their role has expanded to include efforts that address both patients' social needs and the overall well-being of the communities they serve. For nonprofit hospitals in the U.S., this shift is driven not only by the mission of these hospitals but also by legal requirements tied to their tax-exempt status; they must demonstrate community benefit through financial investments reported on their annual tax return, the Internal Revenue Service (IRS) Form 990 Schedule H. However, the community benefit reporting categories included on Schedule H are limited and do not fully capture the breadth of hospital contributions to community health. Nonprofit hospitals deliver essential, often unprofitable services, provide uncompensated care to uninsured patients, address the social needs of their patients, participate in cross-sector collaborations, contribute to healthcare workforce development, and serve as anchor institutions within their communities. By leveraging their resources and influence, many nonprofit hospitals in the U.S. are transforming from traditional healthcare providers into community leaders, actively promoting health equity and improving population health on a larger scale. This expanded role reflects a holistic approach to health that acknowledges the complex interplay between medical care and social factors.