Hospital ethics committees: An untapped resource in charity care allocation
In nonprofit hospitals across the United States, charity care programs serve as lifelines for patients unable to afford medical services. Yet, disparities in how these resources are allocated persist. Hospital ethics committees, traditionally focused on clinical dilemmas, represent a largely overlooked asset in addressing the ethical complexities of charity care distribution.
A patient left behind
I vividly recall witnessing a lapse in charity care. A middle-aged patient arrived at the emergency department with a heart attack and recovered, thanks to timely intervention. However, during her hospitalization, she suffered a stroke that left her with significant impairments.
Her story took a heartbreaking turn when the hospital’s charity care program did not cover the cost of her rehabilitation. While her insurance and charity funds covered the emergency procedures that saved her life, it excluded follow-up care deemed “non-essential,” like physical and occupational therapy. These services, while technically outside the scope of emergency care, were crucial for her to regain independence and avoid further health decline. Charity care programs that focus solely on immediate, life-saving interventions often fail to account for the long-term recovery needs that define a patient’s quality of life. This experience left me questioning: why save a life if the resources to ensure a meaningful recovery are denied?
A role for ethics committees
Hospital ethics committees (HECs) historically have guided decision-making on patient care, but their expertise has seldom extended to organizational ethics. Our recent paper argues that these committees, with expanded training and focus, could bridge this gap. By weighing in on charity care allocation, hospital ethics committees could further the essential healthcare principles of justice, transparency, and accountability.
For example, ethics committees could help develop policies that ensure equitable access to both emergency care and long-term recovery resources like rehabilitation. By applying ethical frameworks, they could address systemic inequities that disproportionately impact underserved populations while maintaining the financial sustainability of healthcare institutions.
Transparency and public trust
One of the most pressing issues in charity care allocation is the lack of clarity in eligibility criteria and application processes. Hospital ethics committees can advocate for transparent policies that empower patients to understand their rights and options. Regular audits, community engagement and public reporting could further enhance trust and accountability, ensuring resources reach those most in need.
Stewardship through value-based design
Ethics committees could also adopt principles from value-based insurance design to guide their recommendations. By prioritizing high-value services and identifying areas of low-value care, HECs can align charity care policies with evidence-based practices. This approach not only ensures effective resource utilization but also reinforces the institution’s commitment to justice.
The path forward
To fully realize this potential, HECs must invest in expanding their expertise to include organizational ethics and resource allocation. Training, interdisciplinary collaboration, and the inclusion of diverse stakeholders are essential steps. While these changes require effort and resources, the payoff is significant: a more equitable healthcare system that addresses disparities while safeguarding institutional sustainability.
As hospitals navigate the complex landscape of charity care, ethics committees have an opportunity to become champions of ethical resource allocation. By embracing this role, they can help reshape healthcare delivery to better serve our communities.
By Dr. Richard Bui, first-year anesthesiology resident at Baylor College of Medicine and a graduate of the Health Policy and Medical Ethics Pathway at Baylor College of Medicine
