After undergoing gallbladder surgery, one patient returned home only to receive a charitable donation request from the very hospital that treated them.
The practice of nonprofit hospitals soliciting funds from their own patients has drawn renewed scrutiny from medical professionals and bioethicists across the country.
Nonprofit hospitals frequently contract with market data firms to screen patients’ wealth and gauge their likelihood to donate based on public records.
These screenings can draw on information including property ownership records and campaign donation histories to build financial profiles of patients.
While wealth screenings have long been used by universities and other nonprofit organizations, experts say hospitals present a fundamentally different ethical situation.
“Needing health care is different than choosing to go to college or going to the opera,” said Nancy Berlinger, a bioethicist with the Hastings Center.
Many physicians say the fundraising practice puts them in an uncomfortable and compromising position with the patients they are supposed to serve.
“It makes doctors very uncomfortable for a lot of reasons — No. 1 is that the doctor is there to see the patient for a problem they have and not to ask the patient for money,” said Dr. Rosalyn Stewart, an internist at Johns Hopkins.
Critics of the practice warn that blending charitable fundraising with medical care could create troubling incentives that ultimately affect the quality of treatment patients receive.
Stewart has raised concerns that financial relationships between donors and care providers could lead to preferential treatment for wealthier patients over others.
“I feel like the risk is we are setting up a two-tiered health care system — one for wealthy patients and one for everyone else,” Stewart said.
The tension between hospital fundraising goals and the duty of care physicians owe their patients sits at the center of the ethical debate surrounding this practice.
Bioethicists argue that patients in medical settings are uniquely vulnerable in ways that make financial solicitation categorically different from other nonprofit fundraising contexts.
The broader question facing hospitals, regulators, and patients is where the line should be drawn between legitimate institutional fundraising and the exploitation of a patient relationship.
