| INTRODUCTION
The key word to the tile of this paper on Economic Challenges for Catholic Health Institutions is the word "Catholic".
We all know about economic challenges of survival but the real challenge is to define a Catholic Health Care system, that will deliver excellent health care, and be economically successful, and at the same time be true to the challenge given to us by Christ, that we should care for all who are seeking our help.
Many would say that is an impossible equation - that economic survival with health care and charity can co-exist in harmony. Charity will lead to the eventual failure of a profitable institution, and should not be contemplated. "Hard enough to survive in this modern world without giving it away as well" &endash; they say! The Challenge
The challenge for this paper then is to explore the proposition that Christ-like charity and economic survival can co-exist successfully for the Catholic health institutions, especially in modern secular affluent communities. The questions to ask are:
- Can the people who have responsibility for management, the professionals who carry out the healing ministry, and the Church, collaborate to explore a fresh understanding of the foundation mission?
- What role is there, particularly for Catholic doctors who have the prime responsibility of patient care and head the team of the healing ministry, to carry out this mission? CATHOLIC
Let us first consider the importance of the "Catholic" label, what it means in the modern world, and how best to uphold its high tradition of service to the poor and those in need.
In earlier times, Catholic Identity was more easily recognised in a Christian dominated world. All those who were sick and in need of help were taken in and treated as the "Good Samaritan" cared for the man who fell into the hands of bandits. This patient was identified as "our neighbour". It was the command of Christ that we should "all go out and do the same". Thus those committed most to the love of Christ, left all, and travelled to distant lands to serve the ill and uncared, often at great sacrifice to themselves.
These days in the western, secular, predominately non-Christian world, it is not easy to live out Christ's command to look after those fallen by the way side. In fact it seems far more clear cut, that to be a good Christian one should serve in a distant country in need, as did the religious men and women of former days. However there is still a need to meet the challenge 'head on' in our own messy, mixed up, chaotic, godless world and find a way to be the "Good Samaritan" in our own countries. But how can we do this, when the patient has to pay his way or the hospital will go out of business?
The man may well have fallen into the hands of bandits, but the best we can do for him is to call the ambulance, and send him to the nearest public hospital where he will be well taken care of. If we can't do that, we may well pass to the other side of the road, and hope or expect that someone else will deal with the problem. So the chance to show the loving concern of Christ &endash; or what we would label as our "Catholic Identity" - is lost. Scripture
For Catholic health institutions this "Catholic Identity" requires deep reflection to understand all its implications. Again we need to go back to scripture to understand its message to us, and the direction pointed out by Christ.
For this image I would suggest the description of the cure of the paralytic, which comes from the gospels of Mark and Luke. You will remember there was chaos in the building where Jesus was addressing the crowd. "Some people with the paralytic and four men who carried him" accepted the difficult challenge, and carried the paralytic up onto the roof, and lowered him with his stretcher through the roof. Jesus "seeing their faith," first of all said, "my friend your sins are forgiven". But when he was challenged on what was considered by the Pharisees and doctors of the law as being more difficult, Jesus cured the paralytic who "walked home praising God" carrying his stretcher, which greatly impressed everyone who witnessed the scene.
Could we see in this image "the friends and the four" who carried the paralytic, as the Catholic health care institution, which carries trust and faith in Christ, for the benefit of the sick?
The word "Catholic" in the eyes of the world can imply "exclusiveness" and "restriction" when in fact the opposite should be the case. Some would choose the word "Christian" to soften the image of being 'Catholic', but this can lead to confusion, misunderstanding, and eventually even to loss of the Catholic identity. But the essence of being 'Catholic' is to relate back to the direct origin from Christ, through his apostles, to the message of "love of God and neighbour". The word 'Love' is the most used and most misused word in the world today. But if we are to describe love, and if in fact, "all were written down, the world itself, I suppose, would not hold all the books that would have to be written" and still we may not understand, or be moved to charity.
The mission then of the Catholic health institution, is to bring healing to all people both physically and spiritually, so as to bring them to consider their own destiny, and then to see the loving hand of God. This in today's world is the New Evangelisation. This is the true meaning of the "Catholic Identity", and this should not be confused with the messengers who may be confused or occasionally get it wrong. INSTITUTIONS
We now need briefly to recall the various types of health institutions, as our response will vary according to the services that are provided.
These institutions range from large acute care hospitals providing for a broad spectrum of complex services and sophisticated technical equipment, to small hospitals providing predominately simple medical treatments. More dedicated hospitals exist for maternity and paediatric services. Day care hospitals, as separate stand alone institutions, are increasing in number with the trend to very short stays in hospital, even for major surgery. Patients are being discharged "quicker and sicker", often with little compassion for all those concerned.
Allied care facilities are available to treat the aged and those requiring nursing care, or hospice care for those who are terminally ill. Mental illness and some significant diseases have their own specialized units. In all there are about 108 000 Catholic health care institutions around the globe. State Run Hospitals
The type of ownership varies from country to country, but basically hospitals are either privately owned or owned by the Government.
Patients are usually treated in state run hospitals at no cost to themselves. These hospitals receive their income via taxes. As government funding is usually not generous, services may be restricted and access constrained so that significant "waiting lists" develop, even for urgent cases; or more sophisticated technology that is beneficial is not available. Private Hospitals
In regard to those institutions privately owned, there are two general categories &endash; that is "For Profit", or "Not for Profit" institutions.
"For Profit" private investment companies generally own hospitals with shareholders. They provide excellent levels of medical treatment and surgical management, but the motivation is to focus on profits, and patients have to pay high fees and come usually from the wealthy end of the market.
"Not for Profit" hospitals are generally owned by religious or charitable foundations. They are similar in most respects to the "For Profit" group, but a proportion of profits are used to carryout charitable works.
In the case of Catholic health care institutions, religious congregations of monks, nuns, and brothers established these over the centuries. They were established often at the invitation of the local Bishop, to fill the need of serving the poor, or for people with no other hospital help available to them. Their motivation was to help those in need, in the best Christian tradition of self-sacrifice and love of fellow man. THE PRESENT
As the years since Vatican II have come and gone, profound changes have taken place to meet the demanding pace of modern living, the explosion of modern treatments, and the declining numbers and ageing of the religious congregations.
The day to day management has passed into the hands of lay administrators, with the tendency to diminish the sense of "Mission", and focus more on the need to supply the best technology, the most modern facilities, and maintain enough profit to continue to survive, in an intense price competitive market place. Administrators may not fully share a Catholic conviction, which increases the gap between being mission focused and profit focused.
More commonly now congregations have wholly passed their institutions into the hands of the laity, with the approval of the Vatican, and supervision of the local Bishop, to see that the hospital continues to be faithful to the Catholic identity. This process establishes a legal entity, called a "Public Juridical Person". The lay group appointed as the trustees, and the board running the hospital, represent the continued presence of the congregation, and undertake to be faithful to their mission.
Finally hospitals may be passed into the hands of private investors, who make no attempt to maintain the Christian ethos, and it may become necessary to remove the Catholic title from the hospital. A religious congregation, especially in remote areas, may manage government hospitals. This process of collaboration may cause difficulties as the Government pushes to have unethical services included (such as terminations), and the problem of "cooperation with immoral services" arise.
In the modern world the perception of the general public may be to see little obvious differences between Catholic "not for profit" hospitals, and the privately run "for profit" hospitals. In both cases usually it is only the 'well-to-do' insured patients that can afford to be treated in both types of hospitals. The fact is, there is little chance for those who are "ill and in need" to be admitted to the care of privately run hospitals.
Thus the very basis on which these hospitals was originally established &endash; that is service to the poor &endash; has been eroded, although they continue to be committed Catholic hospitals. THE CHALLENGE
Let us now consider the ways that the Catholic health institutions can meet the challenge of fulfilling their mission, and at the same time, continue to meet the requirements of being an excellent health institution, and economically sound.
The first requirement is to be faithful to the command to respect life from conception to natural death and all that implies. Ethics committees are a part of the life of all hospitals. People appointed to this committee should have a commitment to uphold the Catholic tradition, and steer the hospital always in the right direction. It would be reasonable for the local Bishop to be aware of the issues dealt with by the ethics committee, which reflect on the Catholic identity.
All hospitals should have a Director of Mission, who has a place on the hospital executive, and has equal standing with the Chief Executive Officer on matters affecting Catholic Identity. Obviously this position will need to be occupied by a person who is Catholic, and deeply committed, as well as being qualified for the position. The position will also involve all who work in the hospital including professionals, administrators, and other workers, to inspire in them, the Christian ethic of compassion for each other and the patients. This may be through regular opportunities for education and training, to all departments to remind them of the mission of the hospital. Compassion will demonstrate itself, by the staff showing concern for all the patients under their care. The staff will endeavour to ease the burden of illness, by resolving the various difficulties that patients encounter. In these days of short stays in hospital, they will show their concern by following up patients, and checking on their progress at home, possibly through outreach programs.
It will also be the duty of the Director of Mission to see that the signs, symbols, and messages such as the mission statement, are displayed around the hospital.
The Chaplains could become more involved in the life of the hospital, and the patients. In the case of short stay patients they could liaise with the parish priest when needed.
All these activities do not much challenge the economics of Catholic hospitals, and should be accepted as part of the life of all hospitals. COMMUNITY
The role of the Catholic health institution is to make itself a part of the wider community, (to be a good "corporate citizen" if you like), and make itself aware of the needs of the community, especially in respect of helping those who are disadvantaged, and require help. On this point, there will be an economic commitment, and in many cases, it would be fair to say, that Catholic health institutions accept this responsibility, and do the best they can to meet these needs.
However for this purpose, I would suggest the formation of an Ethos Committee within the hospital, but also having community representation. The hospital authority or congregation would assign responsibility and allocate resources to the Ethos committee, to promote the hospital's Catholic identity. The committee could be headed by the Director of Mission, and supported by the chief executive officer, the director of nursing, and medical superintendent. Other members could be a Bishop's appointee, a doctor, a nurse, and community representatives. The members should be especially "head hunted" for their Christian commitment, and professional expertise. The committee would identify suitable projects to the hospital administrators, indicating how it would be accomplished, and what funding would be required. It would be a recommendation only to the administration, and would depend on funding being available. The progress of the project, if undertaken, would be audited on a regular basis. This committee would require the infrastructure and administrative support of the hospital to keep it operational. PROJECTS
The projects may be funded all or in part by the hospital. However, where appropriate fundraising activities and volunteer workers may be used. This often has a beneficial affect on all those concerned, both giver and receiver, heightens community awareness, and promotes Catholic identity. DOCTOR'S ROLE
Individually, doctors especially the general practitioners, have in the past been welcomed into the larger hospitals, and have shared with specialists the management of their patients. These days doctors feel isolated, intimidated by modern technology, and unwelcomed by the same hospitals. Although they have a wealth of understanding of their patients they feel marginalised and ignored. It is little wonder then they have little understanding of Catholic identity. The same sentiments may also apply to the Catholic Doctor associations, which lack warm relationships with Catholic hospitals, and become more focused on sustaining their own survival. From all aspects then if the mission in Catholic health care is to flourish, it will need the collaboration and support of everyone especially the doctors. For doctors there is a need to look to support the local Catholic hospital, not only as a place in which to work, but to take a direct interest in its welfare. This means doctors making themselves available for service on committees within the hospital.
Doctors do have busy lives, especially considering family commitments. However where possible we ought to spare time for community service through the Catholic hospital. It may be to fund raise, to supply medications, or equipment, or act as an advocate for someone or a group in special need of care. At other times the hospital may organise a special project, for time to be spent in the country, or overseas, requiring medical personnel.
Some other projects may be assisted by doctors making themselves available to treat special groups, such as hospice patients, pregnancy assistance, or those with substance abuse problems. Other Catholic Health Care Projects
Catholic Health institutions form the largest body involved with health care, apart from government, in most countries. By collaboration and cooperation with each other they have a powerful voice for advocacy, especially for the interests of those who are ill, disadvantaged or unable to help themselves. Collaboration
Collaboration at all levels should be encouraged, so that doctors, nurses, pharmacists, directors of mission, administrators, and others, all form their own special interest national groups. It should be in the interest of the large systems themselves, to encourage the formation of these groups, and relate to their activities such as providing opportunities to have national meetings.
Most importantly there is a great need for the Catholic health institutions to individually, and on a national level, share their mission with their Bishops. The mission of health care is identified and shared in a way that the Church itself becomes much more involved with health matters, in the same way as it did for education. After education, the next most likely time that people consider their human destiny &endash; especially if they have little contact with the Church &endash; is at the time of their illness. This is a time when the Catholic hospital, and its workers and the Catholic Church need to be there to meet the patients concerns. CONCLUSION
We have explored the subject of this paper which is the challenge "Economic challenges for Catholic Health Institutions" which is more a question of can it be done? And is their existence justified?
The answer to both questions is 'Yes', but there is much more to do, to succeed in the mission, to serve all with a preferential option for the poor.
This mission is not fulfilled by mere tokenism, and the real challenge exists to squeeze profits, and maximize opportunities, so that there is very real support for those in need by the Catholic health Institutions, and still survive. |
