Dear Editor,
We applaud Professor Reid for her recent article on ethical issues in health philanthropy.1 The article provides an excellent overview of key ethical dimensions of this important topic. The article also continues the tradition of frank discussion about healthcare philanthropy that has occurred in this journal for many years.E.g., 2 The purpose of our letter is to raise an additional (potentially) problematic aspect of healthcare philanthropy that Reid does not discuss, but which would benefit from ethical analysis. The issue is whether hospital foundations (and perhaps healthcare foundations and charities) unknowingly position the public against necessary health system reforms.
Health system reform in Canada is notoriously difficult and often unsuccessful.3 This appears to be true even when there is near-consensus about reform goals and necessity. A popular example is the clear need, yet chronic inability, to strengthen primary care in many Canadian jurisdictions.3 While much has been written on the roles of health professions, politicians, policymakers, industry, and the public in health system reform3, we suggest that hospital foundations also play a role – and perhaps not a positive one. Specifically, hospital foundations, in seeking to generate revenue for hospital programs, researchers, or infrastructure projects, may be unintentionally perpetuating an acute care bias among Canadians. This is done through marketing and fundraising activities that aim to convince communities that resources are best directed toward more or enhanced acute care.
In other words, the Canadian public “has been persuaded of the value of increasingly specialized and sophisticated health care and health technology, despite the clear absence of effect on health status.”4(p.121) In a recent interview, Canadian health leader David Levine provided an example of where this may have occurred:
Canadian hospitals provide excellent care, but this is not where we should be spending our money. For example, $3 billion was recently spent on the McGill University Health Centre. Who benefits most from this? I’d argue hospital staff will benefit most, not patients who stay for a few days, and certainly not the population. Strengthening primary care will yield significant population health benefits.5(p.e486)
Surveys have shown that many Canadians think more care equals more health, and the majority of Canadians do not appreciate the importance of the social determinants of health.6 We think Canadian hospital foundations bear some of the responsibility for these widely held misconceptions. When foundations perpetuate inaccurate societal beliefs that acute care is most deserving of resources, they diminish political support for health system reforms such as increasing resources for prevention and primary care.
We would welcome an ethical analysis of this situation from Professor Reid or one of her colleagues. Ideally, this analysis would also include guidance for hospital and hospital foundation leaders.
Sincerely,
J. Ross Graham MSc MPA
Centre for Health Services & Policy Research, University of British Columbia, Vancouver, BC
Shannon L. Sibbald PhD
School of Health Studies, Faculty of Health Sciences; Department of Family Medicine & the Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON
References
- Reid L. Ethical issues in health philanthropy. Healthc Manage Forum. 2017;30(6): 298-301.
- Ruderman AP. Starting new health care foundations: is the game worth the candle? Healthc Manage Forum.1989;2(1):6-7.
- Lazar H, Lavis J, Forest P G & Church J (Eds.). Paradigm Freeze: Why it is so hard to reform health-care policy in Canada. Montreal, QC & Kingston, ON: McGill-Queen’s University Press; 2013.
- Lewis S. Creating incentives to improve population health. Prev Chronic Dis. 2010;7(5):120-124.
- Graham JR. Politics, health systems and population health: An interview with David Levine. Can J Public Health. 2016; 107(4-5):e485-e
Healthcare Management Forum 