Federal and state initiatives that aim to improve community accountability of governing boards of not-for-profit hospitals through restructuring do not necessarily achieve the desired benefits in terms of increasing access to services for the underserved, improving community health status and containing costs, according to a study in the Journal of Health Politics, Policy and Law.
The results showed that the level of community accountability among not-for-profit hospitals had a stronger correlation with hospital ownership than with the composition and structure of the hospitals' boards. Additionally, in some circumstances, the boards' practices had a greater impact than board composition or structure on improving community engagement. For example, the study found that an increased level in community engagement occurred when the boards evaluated the CEO on community-related criteria and when incentives were tied to meeting community-based objectives.
The researchers recommended that policymakers who seek to improve the governance of not-for-profit hospitals enact state legislation that directly targets the hospital practices that need improvement, rather than focusing on board composition and structure (Alexander et al., Journal of Health Politics, Policy and Law, April 2008).