Is the Affordable Care Act Encouraging Hospitals to Engage their Communities? Experiences from Appalachian Ohio

  • Berkeley FranzEmail author
  • Daniel Skinner
  • Danielle Dukes
Part of the International Perspectives on Social Policy, Administration, and Practice book series (IPSPAP)


Nonprofit hospitals have the potential to be strong partners in community-based projects. Since the Affordable Care Act was passed in 2010, hospitals have new requirements to engage communities in identifying health needs and developing new community health programs. In this chapter, by Berkeley Franz, Daniel Skinner, and Danielle Dukes, a case study approach is used to explore how hospitals are developing new partnerships and the challenges they face in fostering relationships with the communities where they are located. Potential strategies will be suggested for improving communication between hospital employees and community members in the planning of community-based projects.


Affordable Care Act Hospital partnerships Community-based partners Community-health programs 


  1. American Hospital Association. (2019). Fast Facts on U.S. Hospitals, 2019.
  2. Beatty, K. E., Wilson, K. D., Ciecior, A., & Stringer, L. (2015). Collaboration among Missouri nonprofit hospitals and local health departments: Content analysis of community health needs assessments. American Journal of Public Health, 105(S2), S337–S344.CrossRefGoogle Scholar
  3. Borak, J., Salipante-Zaidel, C., Slade, M. D., & Fields, C. A. (2012). Mortality disparities in Appalachia: Reassessment of major risk factors. Journal of Occupational and Environmental Medicine, 54(2), 146–156.CrossRefGoogle Scholar
  4. Burke, J. G., Truong, S., Albert, S., Steenrod, J., Gibert, C., Folb, B., et al. (2014). What can be learned from the types of community benefit programs that hospitals already have in place? Journal of Healthcare for the Poor and Underserved, 25(1 Suppl), 165–193.CrossRefGoogle Scholar
  5. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative data analysis. London, UK: Sage.Google Scholar
  6. Evashwick, C. J. (2013). Hospitals & community benefit: New demands, new approaches. Chicago, IL: Health Administration Press.Google Scholar
  7. Folkemer, D. C., Spicer, L. A., Mueller, C. H., Somerville, M. H., Brow, A. L. R., Milligan, C. J., & Boddie-Willis, C. L. (2011). Hospital community benefits after the ACA: The emerging federal framework. The Hilltop Institute Issue Brief, January.Google Scholar
  8. Foucault, M. (1973). The birth of the clinic (A. M. Sheridan, Trans.). New York, NY: Vintage.Google Scholar
  9. Franklin, B., & Seavey, O. (2008). Autobiography and other writings. Oxford: Oxford University Press.Google Scholar
  10. Gollust, S., & Lynch, J. (2011). Who deserves health care? The effects of causal attributions and group cues on public attitudes about responsibility for health care costs. Journal of Health Politics, Policy and Law, 36(6), 1061–1095.CrossRefGoogle Scholar
  11. Goffman, E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. New York, NY: Anchor Books.Google Scholar
  12. Halverson, J. A., & Bischak, G. (2008). Underlying socioeconomic factors influencing health disparities in the Appalachian region. Washington, DC: Appalachian Regional Commission. Available at: Scholar
  13. Hendryx, M. (2009). Mortality from heart, respiratory, and kidney disease in coal mining areas of Appalachia. International Archives of Occupational and Environmental Health, 82(2), 243–249.CrossRefGoogle Scholar
  14. Hendryx, M., & Ahern, M. M. (2009). Mortality in Appalachian coal mining regions: The value of statistical life lost. Public Health Reports, 124(4), 541–550.CrossRefGoogle Scholar
  15. Internal Revenue Service. (2018). Private letter ruling: Certified mail -return receipt. Dallas, TX: Tax Exempt and Government Entities Division. Available at: Scholar
  16. Internal Revenue Service. (2013). Community health needs assessments for charitable hospitals. Federal Register, available at:
  17. Jacobs, L. R., & Skocpol, T. (2012). Health care reform and American politics: What everyone needs to know. Oxford, UK: Oxford University Press.Google Scholar
  18. Kaufman, B. G., Thomas, S. R., Randolph, R. K., Perry, J. R., Thompson, K. W., Holmes, G. M., et al. (2016). The rising rate of rural hospital closures. Journal of Rural Health, 32(1), 35–43.CrossRefGoogle Scholar
  19. Kluegel, J., & Smith, E. R. (1986). Beliefs about inequality. New York, NY: Aldine de Gruyter.Google Scholar
  20. Lavin, C. (2008). The politics of responsibility. Urbana, IL: University of Illinois Press.Google Scholar
  21. Ludke, R. L., & Obermiller, P. J. (Eds.). (2012). Appalachian health and well-being. Lexington, KY: University of Kentucky Press.Google Scholar
  22. Morrone, M., Kruse, N. A., & Chadwick, A. E. (2014). Environmental and health disparities in Appalachian Ohio: Perceptions and realities. Journal of Health Disparities Research and Practice, 7(5), 67–81.Google Scholar
  23. National Rural Health Association. (2016). What’s different about rural health care?
  24. Peacock, M., Bissell, P., & Owen, J. (2014). Dependency denied: Health inequalities in the neo-liberal era. Social Science and Medicine, 118, 173–180.CrossRefGoogle Scholar
  25. Pennel, C. L., McLeroy, K. R., Burdine, J. N., & Mataritta-Cascante, D. (2015). Nonprofit hospitals’ approach to community health needs assessment. American Journal of Public Health., 105(3), e103–e113.CrossRefGoogle Scholar
  26. Resnik, D. B. (2007). Responsibility for health: Personal, social, and environmental. Journal of Medical Ethics, 33(8), 444–445.CrossRefGoogle Scholar
  27. Rosenbaum, S. (2015). Additional requirements for charitable hospitals: Final rules on community health needs assessments and financial assistance. Health Affairs Blog, 23.Google Scholar
  28. Rosenbaum, S. (2016). Hospital community benefit spending: Leaning in on the social determinants of health, 94(2), 251–254.Google Scholar
  29. Smith, L., & Hollorman, C. H. (2011). Health status and access to health care services: A comparison between Ohio’s rural non-Appalachian and Appalachian families. Family and Community Health, 34(2), 102–110.CrossRefGoogle Scholar
  30. Starr, P. (1982). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.Google Scholar
  31. Starr, P. (2013). Remedy and reaction: The peculiar American struggle over health care reform. New Haven, CT: Yale University Press.Google Scholar
  32. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  33. Thornton, R. L. J., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs. (Project Hope),, 35(8), 1416–1423.CrossRefGoogle Scholar
  34. Walker, D., & Myrick, F. (2006). Grounded theory: An exploration of process and procedure. Qualitative Health Research, 16(4), 547–559.CrossRefGoogle Scholar
  35. Wewers, M. E., Katz, M., Fickle, D., & Paskett, E. D. (2006). Risky behaviors among Ohio Appalachian adults. Preventing Chronic Disease, 3, 1–8.Google Scholar
  36. Wilson, K. D., Mohr, L. B., Beatty, K. E., & Ciecior, A. (2014). Describing the continuum of collaboration among local health departments with hospitals around the community health assessments. Journal of Public Health Management and Practice, 20(6), 617–625.CrossRefGoogle Scholar
  37. Young, G. J., Chou, C., Alexander, J., Lee, S. D., & Raver, E. (2013). Provision of community benefits by tax-exempt U.S. hospitals. The New England Journal of Medicine, 368, 1519–1527.CrossRefGoogle Scholar
  38. Younis, M. Z. (2013). A comparison study of urban and small rural hospitals financial and economic performance. Online Journal of Rural Nursing and Health Care, 3(1), 38–48.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Berkeley Franz
    • 1
    Email author
  • Daniel Skinner
    • 2
  • Danielle Dukes
    • 2
  1. 1.Heritage College of Osteopathic Medicine, Ohio UniversityAthensUSA
  2. 2.Heritage College of Osteopathic Medicine, Ohio UniversityDublinUSA

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