Paying for population health improvement: Health care and other private sector models

Recent years have brought greater awareness that the circle of contributors to population health improvement beyond the governmental public health agencies, encompasses the health care sector, education, community groups, and many others. Similarly, the question of payment for health has not only grown beyond health care reimbursement to a greater focus on the serious underfunding of governmental public health agencies, but more recently has broadened to recognize the actual and potential financial contributions of many others. For example, the community benefit requirements for non-profit hospitals have been reoriented toward benefits accrued to the entire geographic community around a hospital, not merely to its patient population.  Outside the health realm, community development financial institutions increasingly apply a health lens to their investments in communities, focusing on affordable housing and more equity in food access, among other objectives. In the world of pay for success financing, foundations, government agencies, and for-profit investors support the implementation of interventions  with a track record of success. These private sector models for funding population health improvement, from health care-based mechanisms, to pay for success financing have the potential to alter the social and environmental determinants of health and were the focus of the February 2014 workshop of the Institute of Medicine Roundtable on Population Health Improvement.