temporary basis to enhance monitoring capability and to facilitate increased awareness among nonprofit health-care providers. California’s Office of Statewide Health Planning and Development (OSHPD) conducted a series of workshops and site visits in the first few years following the passage of Senate Bill 697 and produced a report that summarized findings from a general review of reports.³⁶ A state advisory committee was also formed to support the implementation of the statute. The state legislature provided a small pool of funds in 1999 to support the enhancement of OSHPD’s monitoring capacity but withdrew those funds the following year as part of a general cost-saving measure in state government. In a recent survey of nonprofit hospital community benefit practices in California, respondents identified a lack of clarity in the current legislation on the reporting process as a significant challenge (Barnett, 2002). To date, OSHPD staff are limited in their ability to provide specific guidance beyond the current language in the statute, since the law prohibits the promulgation of specific standards without direct action by the California legislature.³⁷

In Massachusetts, the Office of the Attorney General recently completed a multiyear process to develop uniform reporting guidelines and establish a searchable website for posting of community benefit reports. This was made possible by a combination of proceeds from class action insurance settlements and private foundation support.³⁸ While the guidelines lack the specificity needed for a reliable comparative analysis of performance in quantitative terms, the searchable function provides a rich opportunity for qualitative analysis. As public competence in the use of Internet technology increases, access to detailed information by a full spectrum of stakeholders offers significant potential to increase local accountability.

In New Hampshire, the enactment of SB 69 in January 2000 was accompanied by the parallel funding of a statewide health planning process by the state legislature.³⁹ The health planning process focused primarily on the assessment of health-care needs and the development of strategies to increase access to health care, but it also included funding for a series of