: Addressing the health needs of the growing under-and uninsured population, currently 45 million strong, is a complex yet critically important challenge. As the largest sector of healthcare providers, hospitals' role in meeting the health needs of the indigent has become more pivotal and controversial than ever before. The recent hearings held in May 2005 by the House Ways and Means Committee called to investigate hospitals' uncompensated care. In the last 2 decades, 17 states have instituted community benefit laws to regulate and reinforce not-for-profit hospitals' social obligations to the uninsured, in exchange for their tax exemptions. The proposed research will focus on examining the impact of community benefit laws on hospital behavior to (1) measure changes in the hospitals' provision of and financial expenditure on community-oriented health services as a result of state community benefit laws; (2) examine the indirect effects in the provision of and financial expenditure on community-oriented health services by FP hospitals as a result of state community benefit laws; and (3) assess whether the impact of community benefit laws is contingent upon hospital organizational structure and the level of market competition. The study will employ a longitudinal design that tracks the change in community benefit activities and charity care among hospitals in Texas, California, and Florida from 1991 to 2002. The analysis will be based on fixed effects or random effects modeling. The study provides an in-depth examination of whether and how community benefit laws improve hospital provision of community health services and charity care. It affords an opportunity to study the impact of a state heath policy, the strategic responses of hospitals to different designs of policy interventions, and the dynamic interactions among hospitals of different ownership types. Results of the study will inform future policy formulation in relation to community benefit laws, in specific, and hospital and community relationships, in general. ? ? ? ?
