(Reuters Health) - Patients should know if the hospital they choose will restrict their care for religious reasons, but among nearly 650 Catholic hospitals in the U.S., a new study finds that one in five don’t explicitly disclose this information on their websites.
Moreover, less than a third of the hospitals included in the analysis specify how religious affiliation might influence patient care, such as women’s reproductive services or end-of-life care, the study authors report in JAMA.
“Many patients do not anticipate religious healthcare restrictions yet often face conflicts in care,” said senior study author Dr. Maryam Guiahi of the University of Colorado School of Medicine in Aurora.
The United States Conference of Catholic Bishops expects doctors at Catholic healthcare facilities to follow certain ethical and religious directives, which can differ from hospitals without religious affiliation. For instance, the directives only allow counseling about natural family planning versus comprehensive reproductive healthcare options.
“Like any restriction on healthcare, this often has the biggest impact on those who face systemic barriers to care, such as women with low incomes, people of color, LGBTQIA people, young people and people in rural areas,” Guiahi told Reuters Health by email.
As of 2016, Catholic hospitals represented 14.5 percent of all U.S. hospitals, the study team notes. Their number grew by 16 percent between 2001 and 2011, compared to 6 percent growth among all hospitals during that period.
Guiahi and colleagues analyzed the websites of all hospitals listed in the Catholic Health Care directory in 2017 and looked for religious affiliation in the mission statements, the “About Us” pages and homepages. If undisclosed, they searched for words in the mission statement suggesting religious affiliation such as “Jesus,” “Christ” and “gospel.” They also looked for references to the Catholic healthcare directives and related terms such as “ethic” and “directives” and words that sounded limiting or restricting such as “limit,” “end,” and “abortion.”
Of 646 hospitals, 507 websites disclosed their Catholic identity. Among the 139, or about 21 percent, that did not, 107 included religious terms, the study found.
About one quarter, 152 hospitals, cited the directives on their website and 95 provided a direct link to the directives. Among the hospitals that didn’t cite the directives, 28 reported care restrictions and specifically cited end-of-life care restrictions while eight hospitals reported reproductive care restrictions.
“This was surprising to me as we know that most of the conflicts in care have been reports when women have trouble accessing common services including contraception and tubal ligation,” Guiahi said. “Catholic hospitals should be more upfront about these restrictions to avoid conflicts.”
Future studies should investigate how patients prefer to learn about religious affiliation and potential restrictions to care, as well as how to disseminate the information, she added. In Washington state, for instance, hospitals are required to provide policies on reproductive and end-of-life care on their websites.
“It’s clear to me that we also need to start looking closer at how these healthcare system barriers put patients at risk for adverse outcomes,” she said. “We need to better understand when patients who get denials to preventive services like contraception are at greater risk of unintended pregnancies and adverse outcomes.”
Researchers also want to understand how religious affiliation affects the economics of healthcare in the U.S. As hospital mergers occur, some Catholic health systems are developing separate holding companies so they can own both religious and non-religious facilities.
“Historically, Catholic hospitals were always more likely to provide uncompensated services and care for vulnerable, stigmatized populations that for-profit hospitals wouldn’t touch,” said Kenneth White of the University of Virginia in Charlottesville, who wasn’t involved in the study.
“When patients see mergers in their small communities, they often don’t realize what that means or how services may be affected,” he said in a phone interview. “Information about ownership, mission, vision and values should be upfront in any hospital, regardless of affiliation, displayed both online and in the hospital.”
SOURCE: bit.ly/2CruLYz JAMA, online March 19, 2019.