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.). a 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.).
a 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. a Public hospitals in urban areas
suffered from a chronic lack of funding for most of the mid-20th century
(America’s Essential Hospitals, n.d.).
a 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. a The richest
nation in the world was offering antiquated care in deteriorating facilities in its
cities (America’s Essential Hospitals, n.d.). a 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 “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.). a NYC, for example, merged its public hospitals into a “public benefit
corporation”. a 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.). a “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.).
a With this context in mind, and while the public hospitals and not-for-
profit hospitals were morphing throughout the 20th century, 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). a
a 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. a 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. a 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).
a 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. a 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.
a
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/Growing_Numb
er_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
