By Cynthia L. Cooper
Monday, March 5, 2001
Billions of taxpayer dollars go to hospitals run by organized religions. Yet, some deny abortion, abortion counseling, sterilization, emergency contraception and end-of-life services, raising serious questions about the separation of church and state.
(WOMENSENEWS)--Nationwide, hospitals with religious orientations receive at least $45.5 billion in government funding, but these institutions do not provide more services to the poor--and in some cases they provide less--than nonsectarian nonprofit or private hospitals, according to new research.
These findings by The MergerWatch Project, a division of Family Planning Advocates of New York State, were previewed last week at a conference in New York, cosponsored by MergerWatch and the ProChoice Resource Center.
Speakers expressed mounting concerns about religious health care institutions that refuse to provide reproductive health care and end-of-life services based on religious doctrine. Catholic religious and ethical directives, for example, prohibit abortion as well as referral for abortion, sterilization and contraception and emergency contraception to patients, regardless of the patients' preference or religious beliefs. End of life services include permitting patients to choose to end artificial nutrition and hydration.
In 1998 religious hospitals received close to $9 billion in federal funding for Medicaid and other programs, according to the report, which still is in draft form. Citing the most recent data available, the report said religious hospitals received $35.7 billion for Medicare for the elderly and $800 million in other government funds--all together amounting to $45.5 billion.
The $800 million comes from state and local sources, including state and local appropriation funds from tobacco taxes, property tax revenues and payments for services to indigent and low-income people.
Some government support to religious hospitals was not included in the study, such as breaks on the costs of construction financing from using government bond programs.
Religious hospitals constitute 13 percent of the total hospitals in the nation and 18 percent of the total beds, according to MergerWatch.
"As the hospital industry consolidates, more and more patients are finding that their only convenient choice of a hospital is one owned by or affiliated with a religious denomination," the report said.
Catholic health care comprised the largest nonprofit system in the nation in 1999, according to the Catholic Health Care Association of the United States. The size and pace of consolidations and mergers in the 1990s have shaken the health care industry. Catholics for a Free Choice reports that from 1990 to 1998, 127 Catholic and non-religious hospitals merged. Of the nation's mega-hospital systems, 10 of the top 20 are Catholic and one is Adventist, according to the industry magazine, Modern Healthcare.
The MergerWatch study, citing the $35.7 billion in Medicare funding in 1998, determined that nationally, Medicare funding at religious hospitals was 39 percent of their revenue, compared with 30 percent of public hospitals' income, 37 percent of nonsectarian not-for-profit hospitals' and 40 percent of for-profit hospitals' income. The religious hospitals in the study were Catholic, Adventist, Baptist, Methodist and Presbyterian. Beliefs about reproductive choice and the right for critically ill patients to refuse medical care vary among the faiths.
The study was conducted with assistance from the health care consulting agency, Empire Health Advisors of Saratoga Springs, N.Y.
"We should be talking about public accountability," said Lois Uttley, vice president of The Education Fund of Family Planning Advocates. "What strings should be attached to all this money?"
These revenues, however, do not translate to additional services for the currently poor.
"Despite their professed mission to serve the poor, the data show that religious hospitals do not provide more charity care than other non-public hospitals," the report stated.
The report evaluated charity care to the indigent by sampling six states--California, Florida, Maryland, Minnesota, New Jersey and New York. Most of the $5.7 billion in total charity care was reported in public hospitals, which provided $2.4 billion or 42 percent of the total in these states.
Nonsectarian hospitals provided $2.1 billion of the charity care in the six-state sample, more than three times the $604 million delivered by religious hospitals. Religious institutions accounted for only 11 percent of the total charity care in the six states. Public hospitals provided charity care equal to 14 percent of their total patient revenue, while religious hospitals provided care equal to 2.2 percent, an amount comparable to that in private hospitals and nonsectarian not-for-profits.
In addition, the study says that religious hospitals rated poorly in services to low-income people receiving Medicaid. According to one standard measure, religious hospitals showed the lowest percentage of revenue from Medicaid of any group of hospitals, at 12 percent of their total gross revenues, compared with 28 percent for public hospitals and 13 percent for nonsectarian not-for-profit and for-profit hospitals.
Currently, many state and federal laws permit religious health providers to opt out of services that they find objectionable under provisions that religious institutions call "conscience clauses" and which reproductive rights groups variously call "service exemptions" or "noncompliance provisions."
The New York State Catholic Conference argues in published "talking points" that its 41-hospital system provides health care to needy communities, even if they do not provide abortion, abortion referrals, contraception or sterilization. Its mission is rooted in "providing essential medical care to the poor, the sick and the most vulnerable," it states. If required to provide family planning services, Catholic facilities will be "forced out," resulting in "stark and bleak" consequences for the needy.
Last November the American Public Health Association adopted a policy statement addressing the threats to reproductive health care from the growing market power of religiously affiliated health providers. The association praised religious hospitals that have found solutions to prevent any loss of reproductive health services, but said federal legislation and regulatory enforcement are necessary if these services cannot be secured.
"Health care facilities receiving public funding (should) assure the availability of comprehensive reproductive health services," it said.
In the last two years, the United Methodist Church and Presbyterian Church (U.S.A.) also passed resolutions expressing their concern about hospital mergers that eliminated important reproductive health services, according to the Religious Coalition for Reproductive Choice.
Cynthia L. Cooper is a free-lance journalist in New York who specializes in reproductive rights.For further information:
Catholics for a Free Choice: ProChoice Resource Center: Religious Coalition for Reproductive Choice: Catholic positions and perspectives on reproductive concerns and health care: A special Women's Enews feature during March. In 1782, Deborah Sampson, 22, enlisted in the Continental army. Using the name of a brother who died, she concealed her gender by binding her breasts. Sampson served with distinction for a year and a half in upstate New York, where strategic American forts blocked the British goal of seizing the Hudson River Valley. She was chosen for an elite military unit and served in raids on Loyalists and Indians who had been harassing Patriot families in the area. A doctor eventually found her out when treating a fever epidemic. He did not report her, but cared for her and sent her west on a scouting expedition before revealing Sampson's identity in a report praising her service. About two million women have served in the U.S. Armed Forces. --Glenda Crank Holste
Catholics for a Free Choice:
ProChoice Resource Center:
Religious Coalition for Reproductive Choice:
Catholic positions and perspectives on reproductive concerns and health care:
A special Women's Enews feature during March.
In 1782, Deborah Sampson, 22, enlisted in the Continental army. Using the name of a brother who died, she concealed her gender by binding her breasts. Sampson served with distinction for a year and a half in upstate New York, where strategic American forts blocked the British goal of seizing the Hudson River Valley.
She was chosen for an elite military unit and served in raids on Loyalists and Indians who had been harassing Patriot families in the area. A doctor eventually found her out when treating a fever epidemic. He did not report her, but cared for her and sent her west on a scouting expedition before revealing Sampson's identity in a report praising her service.
About two million women have served in the U.S. Armed Forces. --Glenda Crank Holste