Reproductive services at risk in mergers
Are reproductive health services such as contraceptive counseling, tubal ligations, vasectomies, and abortions available at your local hospital? If the rising rate of acquisitions, consolidations, mergers, and joint ventures between religious and secular health care organizations continues, such services may be at risk.
Almost 40% of the 5,200 non-federal hospitals in the United States have been involved in some type of affiliation in the past three years.1 As hospitals battle for market share and continued financial stability, affiliations between religious and secular organizations are becoming increasingly commonplace.
Many of these alliances include unions of non-religious and Catholic systems, according to a recently released report commissioned by the Henry J. Kaiser Family Foundation of Menlo Park, CA.2 According to the report’s findings, Catholic hospitals or health systems have been involved in about 18% of the nation’s hospital affiliations since 1990.
While other religious organizations also operate health care systems and are players in the merger market, the current trend of Catholic affiliations gives pause when considering the set of guidelines used to operate Catholic health care facilities These guidelines, known as the Ethical and Religious Directives for Catholic Health Care Services, state that Catholic institutions are not to provide abortion services or contraceptive sterilization and may not promote or condone contraceptive practices, with the exception of natural family planning.3
How can reproductive health services be preserved when a secular health care system falls beneath such restrictions? The time to answer that question should come before the topic of affiliation is even discussed, say health care analysts and family planning advocates.
"It is much better for physicians and practitioners to speak up before any such merger is announced, because then their feelings and concerns can potentially be taken into account before an agreement is finalized," says Lois Uttley, director of communications for Family Planning Advocates of New York State, an Albany-based group whose MergerWatch project works directly with communities involved in affiliations between religious and secular health care organizations. "It’s a lot more trouble, both for the individual practitioners and for the hospitals, to discover after the fact that there is great community concern about the loss of these services."
Be informed, voice concerns
If an affiliation looms large in the future in your community, become fully informed about what the implications of the union will mean for reproductive health services, offers Carol Weisman, PhD, professor in the department of health management and policy, School of Public Health, at the University of Michigan in Ann Arbor and lead investigator for the Kaiser study. If there is any suggestion that services might be proscribed or discontinued as a result of the affiliation, then providers need to organize and communicate concerns with the director of medical services, administrators, and boards of directors all of whom might be able to influence the outcome of such mergers.
"Although there is a lot of legitimate concern about what could happen to family planning services, one of the points of our study was that family planning services need not be adversely affected in these affiliations if the affiliations are handled correctly, if those most concerned about preserving family planning services are in there doing their jobs," Weisman observes.
There are ways to preserve the services you believe in, she says, and clear communication is key throughout the negotiation process.
The Kaiser report offers four case studies of Catholic and non-Catholic affiliations. Family planning services, including the provision of counseling, contraceptive services, and male and female sterilization, continued relatively unaffected by the union of the two organizations. Abortion, however, proved to be the most contentious issue and was the service most likely to be curtailed as a result of affiliations.
"To a Catholic institution, the provision of abortion is absolutely proscribed in most cases," Weisman explains. "The best you could hope for is some sort of creative negotiation where you work out an arrangement for high-risk late-term abortions to be provided at another site that the Catholic institution is able to distance itself from, either financially or organizationally."
The New York MergerWatch program is tracking a new trend: the merging of religious-based health maintenance organizations with secular units, Uttley says. This trend may prove problematic if the secular HMO serves Medicaid enrollees.
In New York, a Catholic-owned managed care plan for Medicaid recipients, Fidelis Care, refuses to provide coverage or make direct referrals for birth control, sterilizations, emergency contraceptive pills, abortion, or safer sex services, even though these services are covered by Medicaid in New York State.4 Fidelis recently tripled its enrollment by acquiring a comprehensive plan, Better Health, that had offered full services to its Medicaid enrollees, Uttley says.
"A number of HMOs that were serving Medicaid recipients in New York State have dropped out of Medicaid because they contend the reimbursement rate is not high enough," he explains. "As Fidelis is expanding, some of the secular HMOs are retreating."
References
1. Japsen B. Mergers and acquisitions report: Another record year for dealmaking. Modern Healthcare 1996; 26:37-46.
2. Weisman CS, Khoury AJ, Sharpe VA, et al. Is There a Common Ground? Affiliations Between Catholic and Non-Catholic Health Systems and the Availability of Reproductive Health Services. Menlo Park, CA: Kaiser Family Foundation; 1997.
3. Affiliations between religious and secular health care facilities. Fact sheet presented at Emerging Issues in Reproductive Health briefing series, Nov. 4, 1997, New York City. Sponsored by Alan Guttmacher Institute, New York City, Kaiser Family Foundation, Menlo Park, CA, and National Press Foundation, Washington, DC.
4. Uttley LJ. Religious Hospital Mergers and HMOs: The Hidden Crisis for Reproductive Health Care. New York: Family Planning Advocates of New York State; 1997.
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