Bradford Gray, Ph.D.

Bradford Gray, Ph.D., is a Senior Fellow at The Urban Institute and editor of The Milbank Quarterly. Prior to joining The Urban Institute in 2004, Dr. Gray held several senior policy research positions at the New York Academy of Medicine, Yale University, and the Institute of Medicine. He has written extensively about for-profit and nonprofit health care [including The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals (Harvard University Press, 1991)] and has also done research on Medicaid, managed care, ethical issues in research, racial disparities in health care, and the politics of health services research. Dr. Gray received his Ph.D. in sociology from Yale University. A fellow of the Hastings Center, he is also a member of AcademyHealth and the Institute of Medicine.

Dr. Gray’s HCFO-funded work focused on the reporting of community benefit services by nonprofit hospitals in Maryland. The federal tax exemption for nonprofit hospitals hinges on their provision of community benefits through free or discounted services as well as activities that promote community health; however, until 2010, there was no national requirement for reporting the community benefits provided. Such a reporting requirement had been in place in Maryland since 2004, and in a HCFO-funded study Dr. Gray and Mark Schlesinger, Ph.D., Yale University, examined Maryland hospitals’ experience with the 2004 community benefit reporting requirement to understand how it worked, to learn what the reports revealed about hospitals’ community benefit expenditures, and to anticipate what would happen with the Internal Revenue Service (IRS) national reporting requirement introduced in 2010. Based on interviews and quantitative analyses, the research demonstrates the practical realities, advantages, and disadvantages of the community benefit reporting requirement in Maryland.

In their study, Gray and Schlesinger found that Maryland hospitals experienced a steep learning curve regarding internal data collection after the initial introduction of the reporting requirement.  Community benefit spending averaged about seven percent of expenses—primarily for charity care and health professional education—but varied widely across hospitals reflecting local needs and hospital priorities. Hospitals’ reports did not elicit much praise or criticism, but they did allow hospitals to compare their community benefit expenditures to those of other hospitals, leading some to begin doing more. As leaders became more aware of their community benefit spending, many hospitals began a managerial approach to the planning and conduct of community benefit activity, even putting community benefit provision and needs assessment into their strategic planning. Findings from their HCFO-funded study can inform hospital responses to the community benefit provisions in the Affordable Care Act (ACA), which standardize community benefit reporting for 501(c)(3) hospitals as well as require additional activities from nonprofit hospitals to preserve their federal tax exempt status. Articles about the project were published in both Health Affairs and Inquiry.

Additional information about Dr. Gray’s HCFO-funded work is available here.