CATHOLIC HOSPITAL MERGERS: Impacting Reproductive Health

      The recent spate of mergers between Catholic hospitals and secular hospitals has exposed "a culture clash in health care," this week's Modern Healthcare reports. The controversy centers around Catholic doctrinal prohibitions on reproductive services -- abortions, tubal ligations, fertility therapy and use of the "morning-after pill" -- within Catholic church-affiliated facilities. Modern Healthcare reports that 50% of the deals between Catholic and non-Catholic facilities between 1990 and 1997 led to a reduction in reproductive health care services in those institutions, according to a survey by Catholics for a Free Choice. The report also noted that in 1997, "services were discontinued in 40% of the consolidations." A separate Modern Healthcare survey of health providers found that Catholic systems control 509 hospitals, up 11% from 1997, representing 22% of all hospitals in the survey.

Tightening Their Grip?
      Critics of the Catholic deals say "the stewards of non-Catholic hospitals give up too much in deals with Catholic providers." Lois Uttley, director of MergerWatch, an Albany, NY, group that monitors such deals, said, "There are many instances in which a community facing one of these mergers (has) only a minority Catholic (population). The result is that non-Catholics are being forced to have only the hospital care that Catholic rules will allow." Uttley also stresses that many of those affected by the mergers are low income women with nowhere else to turn. MergerWatch "published a guide to help mobilize communities to counter deals that threaten women's services, as has the National Women's Law Center in Washington, [DC]." The center uses antitrust law to fight such mergers, says Judith Applebaum, senior counsel for the center. She says communities can provide information to the Federal Trade Commission or the Justice Department to prompt an antitrust inquiry. "Too often, women's healthcare needs are left by the wayside," she said.

To Merge Is To Choose
      Bishops and other Catholic officials involved with the mergers, however, note that non-Catholic systems are free to contract with any other systems, and are not coerced to contract with Catholic systems. Further, secular hospitals that do merge know at the outset they must accept most Church guidelines. Sister Diana Bader, senior vice president for mission at Denver's Catholic Health Initiatives, said, "If the desired partner were actually being coerced into this relationship, you might have an argument." The Rev. Michael Place, president of the Catholic Health Association, added that many communities simply decide to sacrifice reproductive services under Catholic requirements, as a Catholic arrangement presents them with the best option for financial health. "They're making value judgements about what's in the best interest," he said. Bader also noted that sometimes hospitals will merely accept the new rules. "That will often happen in a community where there (are) a sufficient number of providers so they don't feel there is a loss of services," she said.

Carving Out A Deal
      Many Catholic hospitals "use creative corporate structures in some of their deals to avoid violating the directives." These "corporate carve-outs" compartmentalize controversial services into separate entities, such as outpatient centers, which have no business ties to the Catholic Church. At the Catholic Healthcare West system, "hospitals that come into the system adhere to a document called Common Values for Community Sponsorship, a ... truncated version of the Catholic directives." While some CHW-acquired facilities do not have to adhere completely to the directives, CHW still bans abortions -- except to save the mother's life -- as well as assisted suicide and artificial insemination or fertilization. Carol Bayley, CHW's director of ethics and justice eduction, said, "What we have said to the bishops (is) it's important that we have a relationship with these hospitals. We're not going to baptize them" (Bellandi, 9/28 issue). Click here to read previous coverage of Catholic and secular hospital mergers from the Kaiser Daily Reproductive Health Report. The free Report is available online at www.kff.org.