Hospitals and Religious Restrictions

A billboard commissioned by Hudson Valley, New York activists.

Hospitals are vital health care resources, providing emergency care and acute care services, as well as an increasing menu of outpatient services. For many low-income and elderly patients, the local hospital is an important source of basic primary care. Many of us have special ties to our local hospitals, based on our own personal experiences. We expect our community hospitals to give us accurate and complete information about our treatment options and provide the medical care we need.

Religiously-Sponsored Hospitals

Religiously-sponsored hospitals have long played an important role in the American health care system.  Many of these sectarian hospitals were founded to serve the medical and spiritual needs of members of a particular faith, including patients and physicians who may have experienced discrimination at other hospitals.

Since the mid-20th century, however, religiously-sponsored hospitals have served an increasingly diverse population of patients and employ staff who are often not of the same faith as the hospital sponsors. Because many religious hospitals continue to restrict the services they provide, based on doctrine, there is a growing conflict across the United States between these hospitals and the diverse communities they serve. Patients may have no other convenient choice for hospital care, or may be restricted in where they can seek care because of managed care rules requiring members to use “in-network” hospitals.

Religious restrictions can interfere with the doctor-patient relationship by effectively “gagging” the physician and preventing him/her from describing treatment options that are not permitted at the hospital. Moreover, physicians may be prohibited from providing disapproved services, even in cases of emergency, such as treatment of ectopic pregnancy or the offering of emergency contraception to rape victims.

About 13 percent of all community hospitals in the United States are religiously-affiliated and they contain 18 percent of all the hospital beds, since they tend to be larger than average. To learn more, see “No Strings Attached: Religiously-Sponsored Hospitals in the United States”.

Religious/Secular Hospital Mergers

The participation of religious hospitals in the secular world has been further promoted through consolidation in the hospital industry, which has brought nearby hospitals together in mergers and other forms of business partnerships. When secular (non-religious) community hospitals merge with religiously-sponsored hospitals, the resulting merged health system may adopt religious restrictions, reducing consumer choice and access to health care services.

Low-income women are disproportionately affected by these religious health care restrictions because they tend to be more dependent on hospitals and hospital outpatient clinics for their health care than are more affluent women. Rural women are also especially affected, as they may not have an easily accessible alternative provider of health care.

MergerWatch works with communities across the country when religious/secular hospital mergers are proposed that would reduce patients’ access to comprehensive health care. We provide local advocates with expert analysis of proposed mergers, public education materials, support for grass roots organizing and technical assistance on how to intervene in state regulatory oversight processes. To learn more about religious/secular hospital mergers view Hospital Mergers 101 .

Case Histories

There have been more than 100 mergers between religious and secular (non-religious) hospitals since 1990. In many of the earliest cases, reproductive health services were lost when restrictive religious rules were imposed at the nonsectarian hospital as a condition of the merger.

Since 1997, the MergerWatch Project has been working with community-based coalitions across the country to prevent the loss of reproductive health services when religious and secular hospitals propose to merge. To date, the project’s caseload has included 52 proposed mergers, affiliations or acquisitions involving hospitals in 21 states. The outcomes have included defeating 19 proposed mergers, helping to fashion compromises that preserved some services in 15 cases and unraveling existing mergers in nine cases after the mergers were found to have a negative effect.

The lesson of the project’s work so far is clear: When communities speak up, vital health care services often can be preserved.

To demonstrate how community activists have worked with the MergerWatch Project on hospital mergers, we have assembled a group of case histories. For help in opposing such a merger in your community, contact us at info@mergerwatch.org.

These are divided into four main categories:

Proposals Blocked

In some communities, hospital executives have refused to consider ideas from local residents about how to protect access to services threatened by proposed mergers. In these cases, community activists have then worked to block the merger. These case examples describe some of the strategies that have been used to stop destructive hospital mergers, affiliations or acquisitions.

Compromises

Community activism can often result in a compromise that provides better protections for patients than were contained in the original merger proposal. These case examples demonstrate how some services, such as emergency contraception for rape victims, were protected.

Broken Promises

When hospital executives’ promises to preserve services are not part of legally binding merger agreements, they can be broken. Several communities have learned this lesson the hard way.

Hospital “Divorces”

Some ill-conceived hospital “marriages” end in divorce. These case histories provide insight into the role some communities have played in urging divorce when mergers have threatened health care access and patients’ rights.

For help in opposing such a merger in your community, contact us at info@mergerwatch.org.