Questioning the ethics of pursuing “grateful patients”

Naming a wing, unit or hospital building after a wealthy donor is nothing new, and hospital executives have long had programs to build relationships with “grateful patients” who wish to make a contribution.

A piece this week in the New York Times challenges this practice, and in particular, the ethics of analyzing patient financial data and public records to identify likely donors.

A 2013 change to privacy laws made it easier for hospitals to share information with fundraisers. Now many hospitals have built automated systems to perform “wealth screenings”, combining patient medical records, financial information and publicly-available information such as property records, and political and charitable contributions to identify patients with the means and likelihood of making a large donation. Target patients may receive nicer amenities or a visit from a hospital executive, and follow-up from the hospital’s development staff.

Medical ethicists are split on the practice, with one calling it “unseemly but not illegal or unethical”, but another saying that the practice, and particularly getting physicians involved in the process, is “fraught with danger”.

Previous research has shown that half of oncologists reported being trained to identify potential donors, and a third had been directly asked to solicit donations from patients. The reactions of physicians and patients profiled are mixed. Many doctors feel uncomfortable about the practice but recognize the importance of philanthropy.

Some patients want to express their gratitude through donation—but others expressed concerns about misleading connections between their doctors’ needs and where their donations would be spent.

They also questioned whether large health systems with billions in revenue and millions in profits should be routinely pursuing large donors. Rising public scrutiny around billing practices also highlights the dissonance between asking for philanthropic donations while at the same time aggressively pursuing a schoolteacher or bus driver for thousands of dollars in out-of-network claims.

We’d expect these tensions to continue to grow, as rising margin pressures make philanthropic income even more critical for hospitals—but transparency and a growing healthcare consumer marketplace raise questions of how much of a nonprofit health system’s work truly is “charitable”.