Does Hospital Religious Affiliation Impact Patient Access to Care?

January 02, 2020 - Although religious affiliation is not a consideration during patient access to care, most patients agree their preferences should take precedence over a healthcare organization’s religious or conscientious objections, according to survey data published in JAMA Network Open.

This comes as more hospitals and health systems are coming under the ownership of religious organizations and the US is adopting more conscientious objections protections, the researchers said. Between 2001 and 2016, the number of acute care hospitals owned or affiliated with Catholic institutions increased by 22 percent.

In total, 18.5 percent of hospitals were religiously affiliated in 2016, the researchers added, with 9.4 percent being owned by a Catholic organization, 5.1 percent affiliated with a Catholic group, and 4 percent with another non-Catholic religious group.

“Attendance at religious health care facilities can affect a patient’s access to services because of religious interpretations about care designated by the institution,” the research team explained. “Specific to Catholic health care facilities, clinicians are expected to abide by the Ethical and Religious Directives for Catholic Health Care Services, which places limitations on reproductive and end-of-life-care methods on the basis of the church’s moral teachings.”

Although evidence suggests patient access to care or access to certain services may be limited at certain healthcare organizations, patients do not tend to consider religious affiliation when selecting a hospital. In a survey of nearly 1,500 adult patients, the researchers found that only 6.4 percent considered a hospital’s religious affiliation when accessing healthcare.

The respondents, about 30 percent of whom were Protestant (the most common religion included in the survey), mostly did not care whether a hospital was religiously affiliated, with 71 percent reporting such.

Thirteen percent of respondents preferred a religious healthcare organization while 15 percent said they preferred a hospital to have no religious affiliation.

That being said, 71 percent of survey respondents said they believed their healthcare preferences and wishes should take precedence over a healthcare organization’s religious convictions. This trend was slightly more common among women, 74 percent of whom reported concerns about personal choice and autonomy over their bodies.

“This likely reflects that religious restrictions to care are of greater concern for women because of reproductive care restrictions and explains why so many commented about concerns for personal choice and/or autonomy over one’s own body,” the researchers pointed out.

Sixty-eight percent of men reported the same concerns, the team said, a factor that was largely swayed by a man’s own religiosity.

“Not surprisingly, we found that men who do not associate with a religion were more likely to value personal autonomy over institutional conscience,” the team said. “In contrast, those who reported frequent attendance at a religious facility and/or a higher number of household members were less likely to share those values.”

Access to certain types of end-of-life care and medical aid in dying legislation likely impacted a man’s preference for body autonomy, the researchers added.

These findings underscore a key debate about personal choice and freedom of speech among patients, healthcare institutions, and the medical professionals who work in them. Although a religiously owned hospital may reserve the right to prohibit access to services that run counter to their beliefs, there is also an ethical, medical, and potentially legal obligation to fulfill patients’ medical needs and wishes, the researchers pointed out.

Specifically, conscience rights may present a slippery slope to healthcare discrimination, the team said, prompting a need for better healthcare advocacy in this area.

“Our findings demonstrate that most patients place great emphasis on their autonomy, effectively disagreeing with ongoing protections for institutions to restrict care on the basis of their religious or moral values,” the researchers wrote.

“Advocacy efforts are needed to enact legislation that counterbalances protections for institutions with protections for patients. Because women are disproportionately affected by religious restrictions to care, as are LGBTQIA (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) patients and those in rural settings, advocates must work toward antidiscriminatory policies and legislation.”

Many in the medical space are already focused on this area. After the Department of Health & Human Services (HHS) Office of Civil Rights (OCR) finalized a moral and religious conscience rule, leaders across the country pointed out how the rule could hurt more vulnerable populations and patient access to care.

The rule in question stated that medical professionals or other individuals involved in patient care do not have to provide, participate in, pay for, or provide coverage for a medical procedure that goes against an individual’s religious views.

Patient advocacy groups and state attorneys general were quick to point out the harm this rule could do, banding together to file a lawsuit in the Southern District of New York.

The plaintiffs, who included district attorneys in New York City, Chicago, and Washington DC, and attorneys general New York, Massachusetts, Michigan Pennsylvania, Wisconsin, and a number of other states and municipalities, argued that this civil rights rule infringed on the civil rights of other Americans.

Specifically, the HHS rule did not take into account the right for patients to access medical care by essentially allowing medical providers to deny healthcare on the basis of their own moral convictions. In turn, these providers could deny patients their own rights to health, Massachusetts Attorney General Maura Healey said upon filing the lawsuit.

 “Access to medically accurate and necessary health care is a basic civil right,” Healey said in a statement. “Providers should not be able to use their personal beliefs as an excuse to deny needed care. We are suing to protect the lives and health of our residents.”

The rule was eventually struck down by US District Judge Paul Engelmayer.

The JAMA study also touched on another key point: whether or not a patient is aware she is accessing care in a religiously affiliated hospital.

The researchers pointed to previous studies suggesting that individuals accessing certain types of care prohibited in religiously affiliated hospitals did not know they were visiting a religious hospital.

Going forward, the researchers recommend the medical industry create policies requiring these religious organizations to make clear their moral views and medical access restrictions.

“In Washington state, legislation has passed that enforces all hospitals to report restrictions to care on their websites,” the team concluded. “Because some patients in religious settings may not have other reasonable or viable options for health care access and/or may be faced with life-threatening conditions or need medically indicated care, stronger emergency care protections are urgently needed. Broader consideration should also be given for protections that ensure provision of medically indicated care, even in nonemergent settings.”