Forging new relationships for community benefit: Ethical foundations for collaboration between public health and hospital systems

The new Patient Protection and Affordable Care Act (ACA) revises the conditions that nonprofit hospitals must satisfy in order to qualify for federal tax-exempt status and now requires tax-exempt hospitals to develop strategies to improve community health based on a community health needs assessment (CHNA). By statute, the CHNAs must take into account input from “persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.” These requirements create an opportunity to improve community health by ensuring that hospitals understand the needs of their communities and by improving coordination of hospital community benefits with other efforts to improve community health. Local public health departments have a history of working with communities to improve community health. Although, the ACA gives public health a formal voice in the hospital community benefit process, there are ethical issues that arise in exercising that voice, most importantly is determining how public health should be involved and collaborate with hospitals on assessing, planning and setting community priorities in a way that integrates community values and public health perspectives. This presentation will review how ethical frameworks can be used to strengthen the relationship between local health departments and hospitals to catalyze new opportunities for collaboration for community health benefit.