It may be surprising that the questions went unasked before. The outcomes may be less than shocking. But patients, in a new and nationally representative survey, have told hospitals to bug off with their relentless grubbing for donations from the people they care for.
Doctors and ethicists long have been wary of the huge energy that big hospitals and major academic medical centers sink in to soliciting donations and how institutions’ policies and practices for fundraising may sully public perceptions that medicine is about money and not science or compassionate care, the New York Times reported.
And while medical philanthropy has become an important and central concern of many hospitals and academic centers, driving big and booming “advancement” operations and wrapping doctors into dollar-raising moves, researchers had not delved until now into patients’ thinking.
As Dr. Joseph Carrese, a professor of medicine at Johns Hopkins Berman Institute of Bioethics, told the New York Times about the survey and work he and his colleagues undertook and published on the JAMA Network online: “This is the first study, to my knowledge, reporting what members of the lay public think.”
His colleague, Dr. Reshma Jagsi, an ethicist and radiation oncologist at the University of Michigan and lead author of the survey, added that she worried about striking the right balance between the need for funds and the risk of alienating patients: the newspaper reported:
“We know how important philanthropic funds are to the institutions where we work. Yet we have a discomfort that is natural, especially in the context of that sacred patient-physician relationship.”
The survey’s findings may send some fund-raisers to their tranquilizer stash, reporting unhappiness with hospitals’ money mining among patients long considered ripe targets for donations — individuals who have been treated for serious conditions like cancer and heart disease and the affluent. They were included in the weighted and balanced survey. As the New York Times reported:
“Asked if they approved of doctors directly asking patients to donate when the patients had not brought it up, 85.8% of the general public disapproved, as did 80.5% with incomes above $250,000, 85.5% of cancer patients, and 88.9% of heart patients. Asked if it was permissible for doctors to give patients’ names to the hospital’s fund-raising office without permission, 91.5% of the general public said no, as did 89.1% of wealthy people, 93.7% of cancer patients and 94% of heart patients. Respondents almost universally disapproved of allowing fund-raising offices to check the value of patients’ homes or to review other available information to find out which patients were wealthy.”
Doctors, fund-raisers, and hospitals long have known about the slippery slope institutions can put them all on with the persistent and aggressive seeking of donor cash, the newspaper reported:
“There is a long history of abuses of the doctor-patient relationship, including bribes, kickbacks, self-referrals and charitable contributions, noted Dr. Jonathan Moreno, an ethicist at the University of Pennsylvania. Fund-raising that crosses ethical lines is unacceptable, he added, and not so different. Even Hippocrates worried about these issues, advising doctors not to give special treatment to the wealthy and to provide care without compensation to patients who had little money.
“But current practices at many medical centers are hard to justify, he added. ‘Absent evidence that soliciting patients with financial means makes much difference to an institution’s financial viability, and in an era of rampant mistrust, it’s best to forgo such practices,’ Dr. Moreno said.”
Still, the nonprofit, nonpartisan Kaiser Health News Service reported in 2019 that gifts from wealthy and grateful patients have become a lucrative part of institutions’ finances, with philanthropy experts tallying donations to hospitals in 2017 amounting to $10.4 billion, up from $6 billion in 2004. Hospitals that already had strong resources were pouring bigger efforts into raising yet more money, notably through patient gratitude programs, some of which roll doctors’ in to assist, KHN reported:
“A 2016 survey of 108 hospitals found that 68 had grateful patient programs, according to the Advisory Board, a consulting firm. ‘In the last 10 years we’ve seen a pretty dramatic uptick in strategic attention in the formation of these programs,’ said Nicholas Cericola, a senior consultant with the firm. Large hospitals that say they screen patients’ wealth include those run by MedStar Health in Columbia, Md.; the Johns Hopkins Hospital in Baltimore; Cedars-Sinai in Los Angeles; and NYU Langone Medical Center in New York.
“Donations from patients and their families supplement income streams from private and public insurance programs as well as money raised through traditional methods like charity golf tournaments, dinners or gala balls. ‘It’s a way to get money to the hospital’s bottom line like nothing else they are doing,’ said Bill Tedesco, chief executive officer of DonorSearch, a Maryland company that supplies hospitals with software that helps them conduct wealth screenings.”
Patients, by the way, may be more aware than ever of hospitals bleating for cash. The Covid-19 pandemic rocked the economics of the U.S. health care system, causing barrels of red ink to splash on the balance sheets of doctors, medical practices, clinics, and hospitals and academic medical centers. Many had to shut down non-emergency services, slashing revenues, even as coronavirus-related costs soared. Anyone who has given a dime to any nonprofit, college or university, cultural institution, or big hospital or academic medical center likely has been asked for a donation to help during the pandemic.
But unlike other enterprises, down on bended knee and with a palm up and out, big hospitals and academic medical centers also have shown their governmental clout. The biggest, most affluent, and likely the most secure among these institutions managed to get billions of dollars in federal bailouts awarded to the U.S. health care system, on which Americans spend more than $3.7 trillion annually while receiving some of the poorest outcomes among peers in western industrialized nations. Dozens of the medical recipients of big chunks of federal help also turned around and, as the New York Times reported, they have been “laying off or cutting the pay of tens of thousands of doctors, nurses and lower-paid workers. Many have continued to pay their top executives millions, although some executives have taken modest pay cuts.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This was an ordeal before the pandemic, driven by the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Health care should be a right not a privilege in the wealthiest nation in the world. Alas, unjust and unacceptable inequities flourish in the American system due to age, gender, sexual orientation, and, of course, race and economic standing. Covid-19 gave hospitals and academic medical centers, and, more importantly, doctors and patients a glimpse of a different world in which major care giving institutions’ big, fancy buildings and medical services and costly equipment of dubious need for a moment mattered less than they ever have. A boom in telemedicine and home-based care may have been momentary.
Or maybe not. Challenging times have led the American public to challenge prominent individuals and institutional stalwarts for their long-time problematic practices. The cost of medical care already is crushing for too many Americans, and grateful as they may be for excellent services, how are they supposed to dig deeper to shell out yet more money for it? Hospitals and academic medical centers could easily find themselves on the wrong side of history if they are seen simply as toys and fixations serving mostly the wealthy few. As health care leaders old enough to remember the Sixties might recall, a noted rock group opined, “There’s something happening here [and] what it is ain’t exactly clear …”