Every so often a major newspaper runs a story questioning the ethical underpinnings of hospital fundraising efforts, particularly those involving patients. See this New York Times story from January 2019, and my response here, for one recent example.
The grateful patient program resource suite
Now, the Times has published story under the even more provocative headline "Patient, Can You Spare a Dime?" The article cites a recent JAMA survey to argue that "hospitals are increasingly soliciting donations from patients, and the patients don't much like it." The article even cites one ethicist who compares hospital fundraising to historical "abuses of the doctor-patient relationship," such as accepting bribes and kickbacks.
So is hospital philanthropy as it is practiced today really such an ethical minefield?
In short, no. My article from last January lays out the careful steps that hospital fundraisers can take to administer an ethical and impactful grateful patient program. But I feel compelled to add to that earlier take, because the Times' latest story misses some important context.
In particular, the Times article focused heavily on one recent JAMA study, which surveyed patients and members of the general public about a particular set of fundraising practices—some of which are uncommon or were misleadingly described.
So what do patients really think about hospital fundraising? Here's what our own research shows:
Consistent with Advisory Board’s guidance, my experience shows that professional fundraisers coach doctors and nurses about how to respond to interest from their patients, not to make unfounded requests for financial support. More than 80% of JAMA study participants approve of physicians discussing philanthropy with patients when prompted by the patient, a point not cited in the Times article.
The article also notes that many patients feel uncomfortable with hospitals using wealth screening tools to identify potential donors. That's helpful to know—but it's important to note that this approach is common across all nonprofit fundraising.
Any nonprofit organization with someone's first name, last name, and address can use widely available tools to generate a report on that individual's income, assets, and potential for making philanthropic donations. Universities, museums, and all manner of charitable organizations use these technologies regularly to help them find funding partners. These are increasingly standard tools for running an effective fundraising program at any nonprofit organization, regardless of sector.
Perhaps my greatest frustration when I read stories like this one comes when they discuss the risks of patient fundraising activities that create different service standards for wealthy patients.
Yes, some hospitals and health systems provide higher-tier service—although not better clinical care—to wealthy donors. We should have a conversation about whether that's equitable and appropriate, but we should not criticize its downsides without acknowledging its underlying purpose: Philanthropy helps hospitals improve access and outcomes for those who cannot afford care.
I'm glad researchers and journalists are applying scrutiny to the underlying ethics of patient fundraising. I'm also glad the JAMA study exists, as it provides useful data for hospitals and their fundraising teams. But I regret that the conversation often leaves out important realities about how these programs are operated, as well as their practical effects.
And I regret that the conversation presumes an environment where philanthropy is not necessary to help hospitals meet the health needs of their communities.
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