lion in direct payments and approximately $5 billion in indirect payments (COGME, 2000). In 2000, $260 million were provided for nursing and allied health programs (Medicare Payment Advisory Commission, 2001 as cited in IOM, 2003). In addition to Medicare funding, support for training is provided by the Health Resources and Services Administration (HRSA) and the National Institutes of Health (NIH). In 2002, approximately $400 million was provided by HRSA and about $650 million was provided by NIH to individuals (IOM, 2003; NIH, 2003). These public resources should come with an expectation that the institutions are responsible to societal imperatives. Community benefit offers insights into how these responsibilities can be framed and the scope of potential contributions. State legislatures or other bodies granting state taxpayer monies to these schools of higher learning rarely set policy quid pro quos related to the mission and activities of these higher education programs. There is certainly an opportunity for state government officials to be more explicit about their goals and expectations for higher education in the diversity arena. Such a mandate has periodically led to some focused and successful programs over the years. A very good example is the University of Illinois College of Medicine (Girotti, 1999).
This chapter of the report seeks to educate the public on an issue that has received limited attention outside of the nonprofit health-care arena. In the most basic sense, community benefit principles provide insights for the public expectations of both nonprofit health-care providers and institutions that train these providers. Just as nonprofit hospitals are expected to play a role in addressing priority unmet needs in local communities, health professions schools can appropriately be expected to play a direct role in responding to priority unmet health needs at the local and/or societal level. Specifically, we suggest that community benefit principles form a conceptual cornerstone by which accreditation organizations for health professional training programs and state governments can set expectations for the advancement of societal goals tied to racial and ethnic diversity of the healthcare workforce. The historical and legal antecedents outlined in the first section of this chapter validate the concept of a social contract. Moreover, they demonstrate that changes in social priorities justify periodic adjustments in public expectations and requirements. The Supreme Court in its recent decision in Grutter v. Bollinger et al.50 sent the message that, if