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July 28, 2020

What the New York Times gets wrong about grateful patient fundraising

Daily Briefing

    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.

    What Advisory Board's research shows about grateful patient donations

    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:

    • Patients are generally open to learning about donation opportunities, and those who donate feel positively about doing so. In Advisory Board's 2019 survey of nearly 2,000 patients and their family members, 55% of those who received information from their medical facility about making a donation say they felt somewhat or very positively about being contacted. Nearly 90% of participants in the cited JAMA study agree that "patients feel good when they donate to the hospital or health center where they receive their medical care." As a baseline, most people view philanthropy and fundraising activities as a value-add to society.

    • Physicians don't make direct solicitations of patients for money, and their fundraising colleagues don’t ask them to do so. The JAMA study showed a high rate of discomfort with the idea that doctors would talk to their patients about making donations without the patient having brought it up first. But there is little evidence that this actually happens. In Advisory Board's patient survey, only 4 out of 1,967 respondents said they had received unsolicited information in-person from a physician about making a donation. That's fewer than the 14 respondents who had proactively requested such information, and far fewer than the 113 who said they were open to receiving donation information from a care provider. (Interestingly, a higher number of patients said they'd prefer to hear from a care provider than from professional fundraisers!)

    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.

    Let's not ignore the good created by hospital philanthropy

    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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