A growing body of research has focused on the social and economic determinants that lead to health inequity among different population groups in the US. People in low-income communities face daily economic challenges, “food deserts,” inadequate housing, and other conditions that undermine their health and well-being.
The structural determinants of health inequity, however, are more hidden from view and have received less attention. By structural determinants we mean health care infrastructure – hospital facilities, technologies, equipment, and other resources – that are critical for health care professionals to deliver quality care to their patients. In this report, we focus on differences in hospitals’ access to capital to finance the construction or modernization of facilities, upgrades to the latest technology, and expansion of services to additional patient populations. Access to funding for capital projects has consequences for the growth of revenue and the financial stability of hospitals and for the quality of patient care.
Central to our argument is that federal government policies and funding formulas played a critical role in fostering these inequalities across health care systems in different communities, especially low-income and rural communities. Our evidence draws on our analysis of federal legislation and IRS tax rulings that have led different types of hospitals to have differential access to public subsidies and capital markets — resources necessary for the construction and upgrading of hospital facilities needed to deliver quality care. (author introduction)