Medical Infrastructure - Hospital Merger Aftermath: Secular Vs. Religious Values?

Hospital Mergers, 1996-2000

After peaking in 1997, the total number of hospital mergers and acquisitions headed downward. The number of Catholic/non-Catholic hospital mergers fluctuated between 1996 and 2000 (as did their percentage of all mergers, shown in parentheses). This type of merger peaked in 1998.

Since at least 1994, groups such as Catholics for a Free Choice, the American Civil Liberties Union (ACLU), Physicians for Reproductive Choice and Health (PRCH) and MergerWatch have been criticizing the mergers between Catholic and non-Catholic hospitals. MergerWatch is a project of the Education Fund of Family Planning Advocates of New York State, Inc. Criticism has come, specifically, about the impact of mergers on women's reproductive health care. According to the ACLU, "the problem for reproductive health care arises when a religiously controlled institution tries to impose upon its new partners its restrictions against providing certain reproductive services. As a result of these new business relationships, many hospitals no longer dispense contraceptives, provide abortions, or perform surgical sterilizations. This reorganization of health care constitutes one of the most serious and least visible threats to women's access to comprehensive reproductive health services in years."⁴

There have been mergers between secular and religiously controlled hospitals of other denominations, but those mergers haven't met with as much, if any, criticism. Why? According to PRCH and MergerWatch, other denominations such as Presbyterian, Methodist, Jewish, and Episcopalian "provide health care in a nondenominational manner, and do not use religious doctrine to limit health care services." Others, such as the Seventh Day Adventists, Church of Jesus Christ of Latter-Day Saints, and Baptist hospitals impose restrictions on reproductive health care, but Catholic hospitals tend to have the most restrictive policies, especially where abortion is concerned. Catholic hospitals also make up the majority of the religiously controlled hospitals in the U.S.. 18% of the total hospital beds in the U.S. are in religiously controlled hospitals: 15% in Catholic controlled hospitals, 3% in hospitals controlled by other denominations. (In 2000, the number of Roman Catholic controlled hospitals numbered 621 out of 5,810 hospitals total.)

But is the merging of Catholic and non-Catholic hospitals the cause of this decline in the number of hospitals performing comprehensive reproductive health care? Non-Catholic hospitals that merge with Catholic hospitals are expected to follow the tenets of the document Ethical and Religious Directives for Catholic Health Education, formulated by the National Conference of Catholic Bishops. This document forbids health care providers in Catholic hospitals from providing abortions, information about contraceptives and contraception (including information about AIDS and STD prevention involving condoms), fertility treatments, and sterilizations. According to Catholics for a Free Choice, "nearly half" of the 127 mergers involving Catholic and secular hospitals from 1990 to 1998 resulted in termination of all or some of their reproductive services. This leaves one to wonder about the more than half previously-secular hospitals that did not change their reproductive health policies.

The number of hospitals performing one aspect of women's reproductive health care, abortions, dropped 50% from 1982 to 1996.⁵ The number of counties in the United States with an abortion provider has been decreasing since 1978 (23% in 1978 vs. 14% in 1996).⁶ But, the merger "frenzy" between Catholic and non-Catholic hospitals seemed to start in 1994, when there were a total of 19 Catholic/non-Catholic hospital mergers. (From 1990 to 1993, there were a total of 3:1 in 1990 and 2 in 1992.) In comparison to other Western industrialized countries, in 1996, the abortion rate in the U.S. was still the highest: 22.9 per 1,000 women aged 15-44. This suggests that even with the reduction of abortion services at hospitals, the United States still had the best access to these services in the industrialized world.

In terms of overall health care, "in many cities with both Roman Catholic sponsored hospitals and public or private secular hospitals, the former are often regarded as giving better quality of care."⁷ What is the impact on quality of care? According to a study of hospital mergers in California (370 hospitals between 1994 and 1996), there is little impact on health care (within the hospital) when hospitals merge. The differences in length of stay and inpatient mortality varied only by fractions of a percentage point.

But, what about access to health care after hospitals merge or close? One of the criticisms levied is that some patients will lose access to health care services. The next panel will discuss this issue.

Sources: Monroe, Stephen, M. and Kathy Hammell. Irving Levin Associates. "Hospital M&A Activity Slow in 2000 As Health Care Industry Begins to Stabilize," March 28, 2001. Retrieved September 4, 2002 from http://www.levinassociates.com/pressroom/pressreleases/pr2001/pr103har7.htm. Catholics for Free Choice. "Catholic Health Care." Retrieved September 4, 2002 from http://www.cath4choice.org/nobandwidth/English/healthmergers.htm. American Hospital Association. "Fast Facts on U.S. Hospitals from Hospital Statistics®," November 15, 2001. Retrieved September 4, 2002 from http://www.hospitalconnect.com/aha/resource_center/fastfacts/fast_facts_US_ hospitals.html. Linda Villarosa. "Newest Sill for Future Ob-Gyns: Abortion Training." The New York Times, June 11, 2002. Physicians for Reproductive Choice and Health and MergerWatch. Mergers & You: The Physician's Guide to Religious Hospital Mergers. Retrieved September 4, 2002 from http://www.prch.org/PRCH_Merger_Bro.pdf. B.A. Robinson. "Abortion and Roman Catholic Hospital Mergers," January 29, 2001. Retrieved September 4, 2002 from http://www.religioustolerance.org/abo_ rcc.html. Alan Guttmacher Institute and Physicians for Reproductive Choice and Health "Abortion Rates in Western Industrialized Countries." An Overview of Abortion in the United States, 2002. Retrieved September 4, 2002 from http://www.agiusa.org/pubs/abslide/abort_slides.pdf. Stanley K. Henshaw. "Abortion Incidence and Services in the United States, 1995-1996." Family Planning Perspectives, November/December 1998. Retrieved September 4, 2002 from http://www.agi-usa.org/pubs/journals3026398.html. Reproductive Rights Freedom Network. American Civil Liberties Union. "Hospital Mergers: The Threat to Reproductive Health Services." Retrieved September 4, 2002 from http://www.aclu.org/library/hospital.html. Margie Manning. "Patient care unaffected by hospital mergers." St. Louis Business Journal, January 26, 1998. Retrieved September 4, 2002 from http://stlouis.bizjournals.com/stlouis/stories/1998/01/26/story7.html. "410 U.S. 113 Supreme Court of the United States Roe, et. al. v. Wade, District Attorney of Dallas County." Retrieved September 20, 2002 from http://members.aol.com/abtrbng/410us113.htm.