JMIR Publications

ABSTRACT

Background:

Many U.S. hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual IRS Form 990, including a free-response text section that is known for being ambiguous and unaudited. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparity.

Objective:

Determine the extent to which free response text in Schedule H reveals how nonprofit hospitals address health equity and disparity needs, including alignment with public interest and prioritization.

Methods:

We use free-response text submitted by hospital reporting entities in Part III, V, and VI of IRS Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected with health equity and disparity and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, analyzed Google Trends usage for the same terms during the same period, and used semantic search to understand contextual usage.

Results:

We found increased usage from 2010 to 2019 across all 29 phrase themes related to health equity and disparity. However, usage in themes like LGBTQ and environmental issues remained well below public interest in these topics, and some increased mentions were to explicitly say that no action was taken.

Conclusions:

Hospital reporting entities are demonstrating an increasing awareness of health equity and disparity topics in community benefits tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation exploring alignment of Schedule H text with programming described in Community Health Needs Assessments (CHNAs) to understand if this is associated with increased community benefits programming.