It's a not-very-well-known secret in the health care business.

Wealth Screening: Hospitals Profile Patients To Seek Donations

It’s a not-very-well-known secret in the health care business about which the New York Times recently wrote: “Nonprofit hospitals across the United States are seeking donations from the people who rely on them most: their patients.”

In a world where money often buys access, in this case, the NYT reports it also can buy a differentiated hospital experience: “Many hospitals conduct nightly wealth screenings — using software that culls public data such as property records, contributions to political campaigns and other charities — to gauge which patients are most likely to be the source of large donations.”

“Those who seem promising targets for fund-raising may receive a visit from a hospital executive in their rooms, as well as extra amenities like a bathrobe or a nicer waiting area for their families.”

The Ethics of Wealth Screening

What are the ethics of wealth screening?

The NYT quotes Arthur Caplan, a bioethicist at the New York University School of Medicine: “Wealth screenings strike me as unseemly but not illegal or unethical.”

Said Mark Rothstein, a bioethics professor at the University of Louisville: “Getting physicians involved in philanthropy is something fraught with danger.”

The AMA Journal of Ethics previously addressed the issue in a piece titled “Profiling Patients to Identify Prospective Donors,” which states, “Although soliciting donations from patients is defended on the grounds that the funds pay for the care of those who are unable to pay and improve the quality of care that the community receives, this mixture of wealth screening and patient care raises several ethical issues.”

Identified issues include:

  • “Professional ethics. Parts of the Hippocratic Oath are obsolete, but it remains symbolic of the profession’s commitment to patients. In health care, the professional ethic means “respect for truth telling, confidentiality of personal information, and refusal to exploit others’ problems to achieve personal gain.” Mixing patient care and fundraising can be construed as attempts on the hospital’s part to exploit patients and, hence, as unprofessional behavior.”
  • “Ethics of exclusivity as fairness to patients. The justice, or fairness, of special treatment for donors that we see in the case scenario comes under a concept I call the “ethics of exclusivity.”… So is it truly possible to separate nonmedical perks from patient care activities? Patient care, after all, means caring for the whole person, not just treating the person’s disease.”
  • “The ethics of exclusion as fairness to physicians… Why has the entire medical staff not been oriented to the reality of wealth screening? The hospital may risk losing the trust of excluded physicians.”

The piece concludes: “If wealth screening and patient care must be mixed, then the activity would be safer and more effective if guided by a policy developed with practitioner input.”



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