Social determinants of health and community needs: implications for health legacy foundations.

Mergers and acquisitions of nonprofit hospitals are on the rise. Proceeds from many of these transactions will endow new health legacy foundations (HLFs). These philanthropic entities have substantial potential for charitable investment in US communities. Research indicates that the greatest improvements in population health can be achieved by addressing underlying social factors. Determining whether communities served by HLFs are characterized by poor social determinants of health would provide new information for developing effective grant-making strategies. Our study compared socioeconomic, demographic, and health care access indicators in HLF versus non-HLF counties. Compared with non-HLF counties, HLF counties had significantly higher proportions of racial minorities and multiple socioeconomic factors that rendered them more vulnerable to health disparities and poor health. However, HLF counties had better access to health care. These findings have direct implications for HLF leadership, planning, and grant making.

Health legacy foundations: a new census.

Health care merger and acquisition activity has increased since enactment of the Affordable Care Act in 2010. Proceeds from transactions involving nonprofit hospitals, health systems, and health plans will endow philanthropic foundations, collectively known as health legacy foundations. Building on work by Grantmakers In Health, we undertook a systematic search for these foundations and generated a newly updated, comprehensive database. We found 306 organizations in forty-three states that have been endowed with proceeds from the sale, merger, lease, joint venture, or other restructuring of nonprofit health care assets. These health legacy foundations had $26.2 billion in assets in 2010. Concentrated in the southern United States, foundations originating from hospitals and specialty care facilities (86.6 percent) held mean assets of $64.7 million per funder and typically restricted grants to local communities. Foundations formed from health plans (13.4 percent) held higher mean assets ($222 million), usually served larger areas, and were more likely to engage in health care advocacy. Recent transactions involving smaller and stand-alone nonprofit hospitals will infuse many more communities with unprecedented charitable wealth.