To begin a discussion about the practical difference in
managing the needs of a not-for-profit hospital versus a for
profit hospital, it’s important to understand the context of
hospitals in the US.Physician-staffed and nursing staffed
hospitals came into the public consciousness right at the end of
the civil war(America’s Essential Hospitals, n.d.).Prior to 1920,
most hospitals operated with little income, most physicians
donated their time, and staffing costs tended to be
low.However, many hospitals began to aim to cater to middle
class and upper middle-class clientele, improvements in
available treatments, and the professionalization of the medical
field drive operating costs for hospitals up.Some hospitals
recast themselves as academic institutions or affiliated to
prestigious academic institutions (America’s Essential Hospitals,
n.d.).
The 1930’s were a time of high utilization for many public
hospitals.The idea of a “safety net” was not well known or in
practice yet.Fiscal stresses pushed many patients to public
hospitals, however funding for these institutions was not
keeping up with demand.Not-for-profit hospitals could limit
their available bed for indigent care, while still receiving
funding; public hospitals could not limit indigent care(America’s
Essential Hospitals, n.d.).
Post WW2, demographics shifted from urban to suburban
and so did medical need.Suburban medical needs began to be
met by private insurers.Public hospitals did not far well with the
shifting of demographics as the suburban population sought out
not-for-profit academically affiliated institutions(America’s
Essential Hospitals, n.d.).The shift in demographics also moved
tax bases from urban to suburban centers.This left a poor and
indigent tax base to fund public hospitals in urban areas.Public
hospitals in urban areas suffered from a chronic lack of funding
for most of the mid-20thcentury (America’s Essential Hospitals,
n.d.).
Medicaid and Medicare completely changed the funding
scenario for hospitals in the 1960s.Because of the shifting
demographics after WW2, public hospitals in urban center were
exposed as woefully inadequate.The richest nation in the world
was offering antiquated care in deteriorating facilities in its cities
(America’s Essential Hospitals, n.d.).Medicaid and Medicare
enabled patients to take their medical care to facilities of their
choice.Public hospitals now needed a huge administrative and
operational overhaul to stay afloat (America’s Essential
Hospitals, n.d.).“A variety of proposals floated in the early
1970s involved severing, partially or wholly, the public hospital
from direct control by local governments and municipalities,”
(America’s Essential Hospitals, n.d.).NYC, for example, merged
its public hospitals into a “public benefit corporation”.Denver,
however, chose to merge its public hospitals with its municipal
public health program.Full divestiture was the option of choice
for most public hospitals (America’s Essential Hospitals,
n.d.).“While the consumer price index rose 300 percent
between 1960 and 1980, the per diem cost of hospital beds rose
by 900 percent,” (America’s Essential Hospitals, n.d.).
With this context in mind, and while the public hospitals
and not-for-profit hospitals were morphing throughout the
20thcentury, Catholic health organizations began to slowly
gobble up hospital affiliations (Growing Number of Catholic-Run
Hospitals Raises Concerns : AJN The American Journal of Nursing,
2019).This greatly affect the type of care a facility can offer.Catholic health
systems required all affiliate facilities, secular or not, to follow the catholic
medical directives from the Pope (U.S.C.C.B., 2013).
Catholic affiliated facilities do not allow for end-of-life
care or for reproductive care.I make this statement because in
both cases, the church arbitrarily limits medical treatment based
on their religious beliefs NOT that of the patient.In the case of
reproductive care, Catholic Hospitals actively cause harm to
female patients needing care.This occurs because USCCB does
not allow for proper modern care for spontaneous
abortions.That is the medical term for a miscarriage.In terms
of medical coding, there is no difference between a colloquial
miscarriage and an abortion.The term spontaneous abortion is
the term for any lost pregnancy before it’s term.USCCB also do
not allow for any sterilization treatment for women (Growing
Number of Catholic-Run Hospitals Raises Concerns : AJN The
American Journal of Nursing, 2019).
In communities without non-Catholic hospitals, women
are left with having to carry nonviable fetuses to term, waiting
until their bodies naturally pass all parts of a nonviable fetus
without medical intervention and prohibit tubal ligations even
when the mother’s life is at stake.All of this results harm to
female patients (Growing Number of Catholic-Run Hospitals
Raises Concerns : AJN The American Journal of Nursing,
2019).For profit hospitals can choose to have arbitrary restrictions on abortive
care.
References:
America’s Essential Hospitals. (n.d.).History of Public Hospitals
in the United States. Retrieved April 11, 2022, from
https://essentialhospitals.org/about/history-of-public-
hospitals-in-the-united-states/
George Washington University’s Online Healthcare MBA. (2021,
July 15).For Profit vs. Nonprofit Hospital Administration.
George Washington University. Retrieved April 11, 2022,
from https://healthcaremba.gwu.edu/blog/profit-vs-
nonprofit-hospital-administration/
Growing Number of Catholic-Run Hospitals Raises Concerns : AJN
The American Journal of Nursing. (2019). LWW. Retrieved
April 11, 2022, from
https://journals.lww.com/ajnonline/Fulltext/2019/12000/Gro
wing_Number_of_Catholic_Run_Hospitals_Raises.12.aspx
U.S.C.C.B. (2013). Incorporating the Ethical and Religious
Directives for Catholic Health Care Services into a Nursing
Curriculum.Catholic Social Science Review,18, 249–255.
https://doi.org/10.5840/cssr20131827
