Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

OBJECTIVES: To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs).

STUDY DESIGN: We combined data on tax-exempt hospitals' community benefit spending with data on spending by the corresponding LHD that served the county in which a hospital was located. Data were available for 2 years, 2009 and 2013. Generalized linear regressions were estimated with indicators of hospital community benefit spending as the dependent variable and LHD spending as the key independent variable.

PRINCIPAL FINDINGS: Hospital community benefit spending was unrelated to how much local public health agencies spent, per capita, on public health in their communities.

CONCLUSIONS: Patterns of local public health spending do not appear to impact the investments of tax-exempt hospitals in community health activities. Opportunities may, however, exist for a more active engagement between the public and private sector to ensure that the expenditures of all stakeholders involved in community health improvement efforts complement one another.